Provider Demographics
NPI:1629169222
Name:EVALUATION AND TREATMENT SERVICES
Entity Type:Organization
Organization Name:EVALUATION AND TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CCN II
Authorized Official - Prefix:
Authorized Official - First Name:A. MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:RILLERA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:714-834-6900
Mailing Address - Street 1:1030 W WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-3147
Mailing Address - Country:US
Mailing Address - Phone:714-834-6900
Mailing Address - Fax:
Practice Address - Street 1:1030 W WARNER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3147
Practice Address - Country:US
Practice Address - Phone:714-834-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1629169222
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-27
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 537033261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)