1306056320 NPI number — EAST LOS ANGELES HEALTH TASK FORCE

Table of content: (NPI 1306056320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306056320 NPI number — EAST LOS ANGELES HEALTH TASK FORCE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST LOS ANGELES HEALTH TASK FORCE
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:
CESAR E. CHAVEZ MULTICULTURAL WELLNESS CENTER
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:
1306056320
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2120 E 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90023-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-261-2171
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5648 VINELAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91601-2028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-881-1112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARELLANO
Authorized Official First Name:
SUSANNA
Authorized Official Middle Name:
DELAGADO
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
323-261-2171

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QF0050X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 261QH0100X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1750590402 . This is a "PAMELA LEWIS FNP NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 307749 . This is a "RASHPAL CHELA FNP LIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 10307 . This is a "PAMELA LEWIS FNP LIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CMM70664G , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: C42346 . This is a "CORLISS R. SHELTON MD LIC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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