Healthcare Provider Details

I. General information

NPI: 1114109121
Provider Name (Legal Business Name): PUBLIC HEALTH FOUNDATION ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13300 CROSSROADS PKWY N STE 450
CITY OF INDUSTRY CA
91746-3405
US

IV. Provider business mailing address

13300 CROSSROADS PKWY N STE 450
CITY OF INDUSTRY CA
91746-3405
US

V. Phone/Fax

Practice location:
  • Phone: 800-201-7320
  • Fax: 562-222-7680
Mailing address:
  • Phone: 800-201-7320
  • Fax: 562-222-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. BLAYNE CUTLER
Title or Position: PRESIDENT AND CEO
Credential: MD, PHD
Phone: 562-222-7896