1083148753 NPI number — CENTRAL NEIGHBORHOOD HEALTH FOUNDATION - FONTANA

Table of content: (NPI 1083148753)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083148753 NPI number — CENTRAL NEIGHBORHOOD HEALTH FOUNDATION - FONTANA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL NEIGHBORHOOD HEALTH FOUNDATION - FONTANA
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:
1083148753
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:
7965 SIERRA AVE SUITE # E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FONTANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-356-4459
Provider Business Mailing Address Fax Number:
909-350-8725

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
714 W. OLYMPIC BLVD SUITE # 801
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:
90015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-488-3111
Provider Business Practice Location Address Fax Number:
323-206-5402
Provider Enumeration Date:
04/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
JAHANGIR
Authorized Official First Name:
NUSRATH
Authorized Official Middle Name:
FATIMA
Authorized Official Title or Position:
VP
Authorized Official Telephone Number:
323-234-5000

Provider Taxonomy Codes

  • 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)





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