Basic Information
| Provider Information | |||||||||
| NPI: | 1295233963 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY FAMILY GUIDANCE CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CFGC CCHS | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10929 SOUTH STREET SUITE 208B | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907035340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629245526 | ||||||||
| FaxNumber: | 5629241040 | ||||||||
| Practice Location | |||||||||
| Address1: | 12330 WOODRUFF AVE | ||||||||
| Address2: | |||||||||
| City: | DOWNEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629043552 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2018 | ||||||||
| LastUpdateDate: | 07/18/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SINKO | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5629245526 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMUNITY FAMILY GUIDANCE CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 14662 | CA | Y | Agencies | Community/Behavioral Health |
No ID Information.