Provider Demographics
NPI:1689814592
Name:MEXICAN AMERICAN ADDICTION PROGRAM, INC.
Entity Type:Organization
Organization Name:MEXICAN AMERICAN ADDICTION PROGRAM, INC.
Other - Org Name:MEXICAN AMERICAN ALCOHOLISM PROGRAM, INC.
Other - Org Type:Former Legal Business Name
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 RD
Mailing Address - Street 2:SUITE 65
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2535
Mailing Address - Country:US
Mailing Address - Phone:916-394-2323
Mailing Address - Fax:916-394-2480
Practice Address - Street 1:3612 MADISON AVE
Practice Address - Street 2:SUITES 29
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5068
Practice Address - Country:US
Practice Address - Phone:916-338-6835
Practice Address - Fax:916-339-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340004CN251S00000X, 261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health