1770803462 NPI number — SERVE THE PEOPLE, INC

Table of content: (NPI 1770803462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770803462 NPI number — SERVE THE PEOPLE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERVE THE PEOPLE, 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:
SERVE THE PEOPLE COMMUNITY HEALTH 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:
1770803462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1206 E 17TH ST STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92701-2641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-352-2911
Provider Business Mailing Address Fax Number:
714-380-6235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1206 E 17TH STREET
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92701-2641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-352-2911
Provider Business Practice Location Address Fax Number:
714-352-2903
Provider Enumeration Date:
06/04/2010

Additional Information

Authorized Official

Authorized Official Last Name:
MAGDALENO
Authorized Official First Name:
ROCIO
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
714-619-2854

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  550001441 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: 550001441 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QF0400X , with the licence number: 550001441 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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