Healthcare Provider Details

I. General information

NPI: 1992617161
Provider Name (Legal Business Name): ST. JUDE NEIGHBORHOOD HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N HARBOR BLVD
FULLERTON CA
92835-3801
US

IV. Provider business mailing address

731 S HIGHLAND AVE
FULLERTON CA
92832-2753
US

V. Phone/Fax

Practice location:
  • Phone: 714-446-5100
  • Fax:
Mailing address:
  • Phone: 714-446-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY JASON BROWN
Title or Position: CEO
Credential:
Phone: 208-899-9631