Provider Demographics
NPI:1346415510
Name:MEXICAN AMERICAN ADDICTION PROGRAM, INC.
Entity Type:Organization
Organization Name:MEXICAN AMERICAN ADDICTION PROGRAM, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-394-3481
Mailing Address - Street 1:4241 FLORIN ROAD
Mailing Address - Street 2:SUITE 65
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823
Mailing Address - Country:US
Mailing Address - Phone:916-394-2323
Mailing Address - Fax:916-394-2480
Practice Address - Street 1:4241 FLORIN ROAD
Practice Address - Street 2:SUITE 65
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-394-2323
Practice Address - Fax:916-394-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty