Edgar Ontiveros

NPI #1376821108 in Clearlake, California

Provider Information

NPI Number: 1376821108
Entity Type: Organization
Organization Name: Edgar Ontiveros
Primary Specialty: Case Management
Enumeration Date: Jul 27, 2011
Last Updated: Jul 27, 2011

Practice Location

Address: 15204 LAKESHORE DR
City: Clearlake
State: California
ZIP Code: 95422-8107
Phone: (170) 726-3433

Authorized Official

Name: MR. EDGAR RINCON ONTIVEROS SR.
Title: CASE MANAGER HISPANIC OUTREACH
Phone: 17072634338

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Case Management	251B00000X	Primary

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