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General NPI Number Information
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NPI Number | 1487830279
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Entity Type | Organization
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Legal Business Name | P.E.L.S.A
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Dates
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Enumeration Date | 01/11/2008
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Last Update Date | 01/11/2008
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Provider Practice Location Address
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Address Line | 15363 MONTEREY AVE
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City | CHINO HILLS
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State | CA
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Zip | 91709-2754
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Country | US
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Telephone | 310-383-7624
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Fax | 909-393-6622
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Provider Business Mailing Address
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Address Line | 15363 MONTEREY AVE
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City | CHINO HILLS
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State | CA
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Zip | 91709-2754
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Country | US
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Telephone | 310-383-7624
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Fax | 909-393-6622
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Authorized Official
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Title or Position | VP, CFO, CLINICAL DIR
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Name | MRS. ELSA ROGERS
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Credential | RN, B.A., MSN-C
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Telephone | 310-383-7624
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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 |
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License Number State |
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