1821302027 NPI number — ARROYO VISTA FAMILY HEALTH FOUNDATION

Table of content: (NPI 1821302027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821302027 NPI number — ARROYO VISTA FAMILY HEALTH FOUNDATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARROYO VISTA FAMILY HEALTH 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:
ARROYO VISTA FAMILY 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:
1821302027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6000 N FIGUEROA 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:
90042-4232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-254-5291
Provider Business Mailing Address Fax Number:
323-254-4618

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4837 HUNTINGTON DR N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90032-1981
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-225-0024
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ESTRADAS
Authorized Official First Name:
LORRAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
323-254-5291

Provider Taxonomy Codes

  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X , 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: W6070 . This is a "MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 551140 . This is a "MEDICARE OSCAR/CERTIFICATION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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