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General NPI Number Information
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NPI Number | 1568658847
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Entity Type | Organization
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Legal Business Name | SANTA MARGARITA SOLUTIONS CENTER
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 06/07/2013
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Provider Practice Location Address
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Address Line | 22362 GILBERTO SUITE 130
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2139
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Country | US
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Telephone | 949-589-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 22362 GILBERTO SUITE 130
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-2139
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Country | US
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Telephone | 949-589-5700
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. JULIE NADINE KECK
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Credential | PH.D.
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Telephone | 949-589-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY14768
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License Number State | CA
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