Prototypes
NPI #1265069355 in Pomona, California
Provider Information
- NPI Number
- 1265069355
- Entity Type
- Organization
- Organization Name
- Prototypes
- Primary Specialty
- Counselor - Addiction (Substance Use Disorder)
- Enumeration Date
- Mar 26, 2020
- Last Updated
- Mar 27, 2020
Practice Location
- Address
- 831 E ARROW HWY
- City
- Pomona
- State
- California
- ZIP Code
- 91767-2535
- Phone
- (909) 624-1233
Authorized Official
- Name
- EVANNE BREE JACKSON
- Title
- SUD COUNSELOR II
- Phone
- (909) 624-1233
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder) |
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