MONTE NIDO LAKE VISTA, LLC
NPI 1609501279
Clinic/Center - Adolescent and Children Mental Health in Yorba Linda, CA

Q: What is Monte Nido Lake Vista, LLC's NPI number?

The NPI number for Monte Nido Lake Vista, LLC is 1609501279. It was assigned to this organization in the NPPES registry on July 19, 2022. The provider is doing business as Clementine Orange County.

Q: What is Monte Nido Lake Vista, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Adolescent and Children Mental Health, with taxonomy code 261QM0855X.

Active since July 19, 2022CLIA 05D2303763 · Waiver

17059 EL CAJON AVE, YORBA LINDA, CA 92886(657) 363-4633(714) 961-6052 Get Directions Write a Review

NPPES record last updated: July 19, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Monte Nido Lake Vista, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MONTE NIDO LAKE VISTA, LLC (NPI 1609501279), doing business as Clementine Orange County, is a healthcare organization registered as an adolescent and children mental health in Yorba Linda, California and active in the NPI registry since July 2022. The organization holds a CLIA Waiver certificate valid through April 29, 2028 and lists Mike Bagley, Chief Financial Officer, as its authorized official.

NPPES Registry Identity

NPI1609501279

Entity TypeOrganization

Primary Taxonomy261QM0855X

Legal Business NameMONTE NIDO LAKE VISTA, LLC

Location Address17059 EL CAJON AVEYorba Linda, CA 92886-2220

Mailing Address6100 Sw 76th StSouth Miami, FL 33143-5002 · (305) 663-1876

Phone(657) 363-4633

Fax(714) 961-6052

Organization SubpartNo

Authorized OfficialMike BagleyChief Financial Officer · (305) 663-1876

Enumeration DateJuly 19, 2022

NPPES CertifiedJuly 7, 2022

✔ NPI 1609501279 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Adolescent and Children Mental HealthAmbulatory Health Care Facilities

Taxonomy Code261QM0855X

Definition

An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training.

17059 EL CAJON AVE, Yorba Linda, CA 92886

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Other Names 1

Doing Business AsClementine Orange County

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Kaiser Permanente.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2303763

Monte Nido Lake Vista, LLC Dba Clementine Orange County · Yorba Linda, CA

Active · expires Apr 29, 2028

CLIA Number05D2303763

Laboratory TypeCongregate Living Health

Certificate Effective DateApril 30, 2026

Certificate Expiration DateApril 29, 2028

Laboratory DirectorMolly M. Perlman

Laboratory Phone(657) 363-4633

Laboratory LocationMonte Nido Lake Vista, LLC Dba Clementine Orange County17059 El Cajon Ave, Yorba Linda, CA 92886

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Monte Nido Lake Vista, LLC's NPI number?

The NPI number for Monte Nido Lake Vista, LLC is 1609501279. It was assigned to this organization in the NPPES registry on July 19, 2022. The provider is doing business as Clementine Orange County.

Where is Monte Nido Lake Vista, LLC located?

Monte Nido Lake Vista, LLC is located at 17059 El Cajon Ave, Yorba Linda, CA 92886. The listed phone number is (657) 363-4633.

What is Monte Nido Lake Vista, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Adolescent and Children Mental Health, with taxonomy code 261QM0855X.

Does Monte Nido Lake Vista, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2303763) is associated with this NPI, valid through April 29, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Monte Nido Lake Vista, LLC accept?

Health plans from Kaiser Permanente list Monte Nido Lake Vista, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Monte Nido Lake Vista, LLC was last updated on July 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.