Basic Information
| Provider Information | |||||||||
| NPI: | 1770803462 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SERVE THE PEOPLE, INC | ||||||||
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| OtherOrganizationName: | SERVE THE PEOPLE COMMUNITY HEALTH CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1206 E 17TH ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927012641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143522911 | ||||||||
| FaxNumber: | 7143806235 | ||||||||
| Practice Location | |||||||||
| Address1: | 1206 E 17TH STREET | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927012641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7143522911 | ||||||||
| FaxNumber: | 7143522903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2010 | ||||||||
| LastUpdateDate: | 06/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | MAGDALENO | ||||||||
| AuthorizedOfficialFirstName: | ROCIO | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7146192854 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SERVE THE PEOPLE, INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 550001441 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QF0400X | 550001441 | CA | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261Q00000X | 550001441 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.