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General NPI Number Information
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NPI Number | 1275959728
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Entity Type | Organization
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Legal Business Name | TIKVAH CENTER
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Dates
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Enumeration Date | 03/07/2014
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Last Update Date | 03/07/2014
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Provider Practice Location Address
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Address Line | 22930 CANYON VIEW DR
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City | CORONA
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State | CA
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Zip | 92883-9148
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Country | US
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Telephone | 951-254-9736
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Fax | 951-254-9737
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Provider Business Mailing Address
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Address Line | 22930 CANYON VIEW DR
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City | CORONA
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State | CA
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Zip | 92883-9148
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Country | US
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Telephone | 951-254-9736
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Fax | 951-254-9737
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | LILLY ALEJANDRA FLORES
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Credential | B.C.B.A.
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Telephone | 626-757-4940
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1-10-7080
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License Number State | CA
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