MEDICARE: COUNTY OF SAN BERNARDINO

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
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center	ZZZ74743Z	CA

General Provider Information

NPI Number	:	1740481613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF SAN BERNARDINO

Provider Business Mailing Address
First Line	:	18818 US HIGHWAY 18
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-2323
Country	:	US
Telephone Number	:	760-995-8868
Fax Number	:	760-995-8937

Provider Business Practice Location Address
First Line	:	18818 US HIGHWAY 18
Second Line	:
City	:	APPLE VALLEY
State	:	CA
Zip	:	92307-2323
Country	:	US
Telephone Number	:	760-995-8868
Fax Number	:	760-995-8937

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	ERICA OCHOA
Credential	:
Telephone Number	:	909-388-0882

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	06/23/2023

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Directions to “COUNTY OF SAN BERNARDINO ” Practice Location

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