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General NPI Number Information
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NPI Number | 1205620739
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Entity Type | Organization
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Legal Business Name | EQGENIX INC
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 254 CHAPMAN RD STE 209
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City | NEWARK
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State | DE
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Zip | 19702-5422
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Country | US
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Telephone | 888-824-7244
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Fax |
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Provider Business Mailing Address
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Address Line | 29634 BONANZA PL
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City | CANYON LAKE
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State | CA
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Zip | 92587-7923
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Country | US
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Telephone | 949-374-9522
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | YVONNE HALL
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Credential |
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Telephone | 949-374-9522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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