1609053693 NPI number — THE CHILDREN'S CLINIC, SERVING CHILDREN AND THEIR FAMILIES

Table of content: (NPI 1609053693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609053693 NPI number — THE CHILDREN'S CLINIC, SERVING CHILDREN AND THEIR FAMILIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE CHILDREN'S CLINIC, SERVING CHILDREN AND THEIR FAMILIES
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:
1609053693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 E 28TH ST STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90806-2784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-264-3985
Provider Business Mailing Address Fax Number:
562-216-6197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 E COLUMBIA ST STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90806-1620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-933-0400
Provider Business Practice Location Address Fax Number:
562-933-0415
Provider Enumeration Date:
01/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LAWLER
Authorized Official First Name:
JINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATIONS OFFICER
Authorized Official Telephone Number:
562-264-3985

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 05-1110 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: EAP11466F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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