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General NPI Number Information
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NPI Number | 1770224222
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Entity Type | Organization
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Legal Business Name | FOUR SQUARE CLINICALS OF CALIFORNIA A PROFESSIONAL NURSING CORPORATION
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Dates
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Enumeration Date | 04/06/2022
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Last Update Date | 04/06/2022
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Provider Practice Location Address
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Address Line | 418 N CLINE COURT
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City | PLACENTIA
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State | CA
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Zip | 92870
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Country | US
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Telephone | 714-345-6944
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Fax |
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Provider Business Mailing Address
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Address Line | 650 N ROSE DRIVE SUITE 472
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City | PLACENTIA
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State | CA
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Zip | 92870
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Country | US
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Telephone | 714-345-6944
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Fax |
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Authorized Official
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Title or Position | CLINICAL OPERATIONS DIRECTOR
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Name | STEVEN HUERTA
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Credential | DNP, PMHNP-BC
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Telephone | 714-345-6944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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