1093181448 NPI number — EL PROYECTO DEL BARRIO, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093181448 NPI number — EL PROYECTO DEL BARRIO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL PROYECTO DEL BARRIO, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EL PROYECTO DEL BARRIO,INC NORTHRIDGE COMMUNITY CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093181448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8902 WOODMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLETA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91331-6401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-830-7133
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18250 ROSCOE BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
NORTHRIDGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91325-4226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-429-1740
Provider Business Practice Location Address Fax Number:
818-830-7280
Provider Enumeration Date:
08/19/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SANCHEZ
Authorized Official First Name:
CORINNE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
818-830-7133

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X , with the licence number: 550003780 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1093181448 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1538130893 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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