1356880967 NPI number — YOU ARE THE DIFFERENCE FOUNDATION

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 1356880967 NPI number — YOU ARE THE DIFFERENCE FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOU ARE THE DIFFERENCE FOUNDATION
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:
Provider Other Organization Name Type Code:
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:
1356880967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1249 S DIAMOND BAR BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DIAMOND BAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91765-4122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-861-2809
Provider Business Mailing Address Fax Number:
909-396-4429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 S BURRIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COMPTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90221-3945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-608-0150
Provider Business Practice Location Address Fax Number:
310-608-6920
Provider Enumeration Date:
02/15/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WOODS
Authorized Official First Name:
BILLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
310-608-0150

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , 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)





Copyright © 2007-2025 www.npivalidator.com