Basic Information
| Provider Information | |||||||||
| NPI: | 1023748571 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRIENDS OF FAMILY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 S IDAHO ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906316047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626900400 | ||||||||
| FaxNumber: | 5626903182 | ||||||||
| Practice Location | |||||||||
| Address1: | 14350 WHITTIER BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | WHITTIER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906052141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626938541 | ||||||||
| FaxNumber: | 5626903182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2022 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | ARIAS | ||||||||
| AuthorizedOfficialFirstName: | NICOLIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 5626900400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
ID Information
| ID | Type | State | Issuer | Description | FHCX10068 | 05 | CA | MEDICAID |