MONTE NIDO LAKE VISTA LLC NPI 1609501279

NPI Information

  • NPI: 1609501279
  • Provider Name: MONTE NIDO LAKE VISTA, LLC
  • Classification: Clinic/Center - 261QM0855X
  • Specialization: Adolescent and Children Mental Health
  • Entity Type: Organization
  • CLIA Number: 05D2303763
  • Address: 17059 EL CAJON AVE
    YORBA LINDA, CA
    ZIP 92886
  • Phone: (657) 363-4633

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NPI Details

MONTE NIDO LAKE VISTA, LLC is an adolescent and children mental health clinic center in Yorba Linda, CA. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. MONTE NIDO LAKE VISTA, LLC NPI is 1609501279. The provider is registered as an organization entity type.

The provider's business location address is:

17059 EL CAJON AVE
YORBA LINDA, CA
ZIP 92886-220
Phone: (657) 363-4633
Fax: (714) 961-6052

The provider's authorized official is Mike Bagley .
The authorized official title is Chief Financial Officer and has the following contact phone number (305) 663-1876.

The CLIA number assigned to this NPI record is 05D2303763 - other - congregate living health with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/19/2022 and was last updated on 7/19/2022.

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:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QM0855XClinic/CenterAdolescent and Children Mental HealthYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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