Healthcare Provider Details

I. General information

NPI: 1265343107
Provider Name (Legal Business Name): BOYS & GIRLS CLUBS COMMUNITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13645 CLINTON ST
GARDEN GROVE CA
92843-4110
US

IV. Provider business mailing address

10540 CHAPMAN AVE
GARDEN GROVE CA
92840-3101
US

V. Phone/Fax

Practice location:
  • Phone: 714-530-0430
  • Fax:
Mailing address:
  • Phone: 714-530-0430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA SEPULVEDA
Title or Position: VICE PRESIDENT COMMUNITY IMPACT
Credential:
Phone: 714-852-1616