Basic Information
| Provider Information | |||||||||
| NPI: | 1699971010 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CALIFORNIA HISPANIC COMMISSION ON ALCOHOL AND DRUG ABUSE, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1901 ROYAL OAKS DRIVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 95815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164435473 | ||||||||
| FaxNumber: | 9163075900 | ||||||||
| Practice Location | |||||||||
| Address1: | 2607 COLORADO BOULEVARD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232224591 | ||||||||
| FaxNumber: | 3232224614 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 07/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9164435473 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CALIFORNIA HISPANIC COMMISSION ON ALCOHOL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 7519 | 01 | CA | MEDI-CAL PROVIDER NUMBER | OTHER |