Basic Information
| Provider Information | |||||||||
| NPI: | 1780959783 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AIDS HEALTHCARE FOUNDATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6255 W SUNSET BLVD FL 21 | ||||||||
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| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900287422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238605200 | ||||||||
| FaxNumber: | 8832417615 | ||||||||
| Practice Location | |||||||||
| Address1: | 1516 E COLONIAL DR | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328034740 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4074471670 | ||||||||
| FaxNumber: | 4074471671 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2012 | ||||||||
| LastUpdateDate: | 09/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | STIDHAM | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OF MANAGED CARE | ||||||||
| AuthorizedOfficialTelephone: | 3234365025 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.