STATE OF CALIFORNIA - DEPARTMENT OF DEVELOPMENTAL SERVICES NPI 1093085565

NPI Information

STATE OF CALIFORNIA - DEPARTMENT OF DEVELOPMENTAL SERVICES is a federally qualified health center (fqhc) clinic center in Pomona, CA. STATE OF CALIFORNIA - DEPARTMENT OF DEVELOPMENTAL SERVICES NPI is 1093085565. The provider is registered as an organization entity type.
The provider Is Doing Business As Lanterman Community Clinic.

The provider's business location address is:

3530 W POMONA BLVD
POMONA, CA
ZIP 91768-238
Phone: (909) 444-7000

The provider's authorized official is Mark Hutchinson .
The authorized official title is Deputy Director and has the following contact phone number (916) 654-1897.

The enumeration date for this NPI number is 12/30/2011 and was last updated on 1/17/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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