Basic Information
| Provider Information | |||||||||
| NPI: | 1477685006 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIENVENIDOS CHILDREN'S CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 N SAN GABRIEL BLVD | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911073429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266961270 | ||||||||
| FaxNumber: | 6267987899 | ||||||||
| Practice Location | |||||||||
| Address1: | 258 W BADILLO ST | ||||||||
| Address2: | |||||||||
| City: | COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917231906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265431121 | ||||||||
| FaxNumber: | 6265431138 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 03/22/2016 | ||||||||
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| AuthorizedOfficialLastName: | GONZALEZ | ||||||||
| AuthorizedOfficialFirstName: | MIRIAM | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF PROGRAM OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 2137855906 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MA | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7575A | 05 | CA | MEDICAID |