Provider Demographics
NPI:1265502322
Name:SAN FERNANDO MENTAL CENTER
Entity Type:Organization
Organization Name:SAN FERNANDO MENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR, R.N.
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ATTALLA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:818-832-2400
Mailing Address - Street 1:10605 BALBOA BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-6342
Mailing Address - Country:US
Mailing Address - Phone:818-832-2400
Mailing Address - Fax:818-832-2567
Practice Address - Street 1:10605 BALBOA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6342
Practice Address - Country:US
Practice Address - Phone:818-832-2400
Practice Address - Fax:818-832-2567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA477378251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health