Provider Demographics
NPI:1063123669
Name:CORDILLERAS MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:CORDILLERAS MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:NELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LASTIMOSA
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, RN
Authorized Official - Phone:510-455-6334
Mailing Address - Street 1:1185 HILLCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-2234
Mailing Address - Country:US
Mailing Address - Phone:650-445-3113
Mailing Address - Fax:
Practice Address - Street 1:200 EDMONDS RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-3813
Practice Address - Country:US
Practice Address - Phone:650-367-1890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health