Basic Information
| Provider Information | |||||||||
| NPI: | 1275064180 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MENTAL HEALTH SYSTEMS SUCCESS FIRST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9540 CENTER AVE SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099802789 | ||||||||
| FaxNumber: | 9099802689 | ||||||||
| Practice Location | |||||||||
| Address1: | 9540 CENTER AVE | ||||||||
| Address2: | |||||||||
| City: | RANCHO CUCAMONGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917305840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099802789 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2017 | ||||||||
| LastUpdateDate: | 03/22/2017 | ||||||||
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| AuthorizedOfficialLastName: | JUAREZ | ||||||||
| AuthorizedOfficialFirstName: | CLAUDIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | FAMILY SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 9099802789 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.