Basic Information
| Provider Information | |||||||||
| NPI: | 1871818138 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FRIENDS OF FAMILY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 S IDAHO ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906316047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626900400 | ||||||||
| FaxNumber: | 5626903182 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S IDAHO ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906316047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626900400 | ||||||||
| FaxNumber: | 5626903182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2010 | ||||||||
| LastUpdateDate: | 04/29/2020 | ||||||||
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| AuthorizedOfficialLastName: | TA | ||||||||
| AuthorizedOfficialFirstName: | DAWN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5626900400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 04/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A106562 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 363LF0000X | 13382 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 1223P0221X | 50015 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | Pediatric Dentistry | 207R00000X | A80057 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | G51286 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | A81700 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 20A9142 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | 363LP0200X | 8539 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.