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NPI Code Detail

MEDICARE: EVALUATION AND TREATMENT SERVICES

MEDICARE: EVALUATION AND TREATMENT SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)RN 537033CA

General Provider Information

NPI Number : 1629169222
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVALUATION AND TREATMENT SERVICES
Provider Business Mailing Address
First Line : 1030 W WARNER AVE
Second Line :
City : SANTA ANA
State : CA
Zip : 92707-3147
Country : US
Telephone Number : 714-834-6900
Fax Number :
Provider Business Practice Location Address
First Line : 1030 W WARNER AVE
Second Line :
City : SANTA ANA
State : CA
Zip : 92707-3147
Country : US
Telephone Number : 714-834-6900
Fax Number :
Authorized Official
Title or Position : CCN II
Name : A. MICHAEL P. RILLERA
Credential : RN
Telephone Number : 714-834-6900
Provider Enumeration Date : 09/27/2006
Last Update Date : 04/23/2008

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Directions to “EVALUATION AND TREATMENT SERVICES ” Practice Location

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