Provider Demographics
NPI:1558443374
Name:LA FAMILIA FAMILY TREATMENT SERVICES
Entity type:Organization
Organization Name:LA FAMILIA FAMILY TREATMENT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MELLONI
Authorized Official - Suffix:
Authorized Official - Credentials:MA PSYCHOLOGY
Authorized Official - Phone:714-479-0120
Mailing Address - Street 1:1905 N. COLLEGE AVE.
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706
Mailing Address - Country:US
Mailing Address - Phone:714-479-0120
Mailing Address - Fax:714-479-0153
Practice Address - Street 1:1905 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2334
Practice Address - Country:US
Practice Address - Phone:714-479-0120
Practice Address - Fax:714-479-0153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30001DN251S00000X
CA300010DN251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherFAMILY TREATMENT SERVICES