1730908146 NPI number — COPA DE ORO COMMUNITY HEALTH CENTER

Table of content: (NPI 1730908146)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730908146 NPI number — COPA DE ORO COMMUNITY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COPA DE ORO COMMUNITY HEALTH CENTER
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:
1730908146
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1127 WILSHIRE BLVD STE 1112
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:
90017-4002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12052 IMPERIAL HWY
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
NORWALK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-261-9330
Provider Business Practice Location Address Fax Number:
562-543-3134
Provider Enumeration Date:
10/03/2024

Additional Information

Authorized Official

Authorized Official Last Name:
DOLATABADI
Authorized Official First Name:
MOHAMMAD
Authorized Official Middle Name:
SADEGH
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
310-404-7171

Provider Taxonomy Codes

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

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





Copyright © 2007-2025 www.npivalidator.com