1649600487 NPI number — AIDS HEALTHCARE FOUNDATION

Table of content: (NPI 1649600487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649600487 NPI number — AIDS HEALTHCARE FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AIDS HEALTHCARE 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:
6
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:
1649600487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19300 S. HAMILTON AVENUE
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
GARDENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90248-4411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-464-8241
Provider Business Mailing Address Fax Number:
310-771-0621

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3940 FOURTH AVENUE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-7193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-574-9700
Provider Business Practice Location Address Fax Number:
619-574-9701
Provider Enumeration Date:
11/14/2013

Additional Information

Authorized Official

Authorized Official Last Name:
REIS
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
323-860-5200

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  PHY51043 , 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: 3065340 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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