Healthcare Provider Details

I. General information

NPI: 1548610322
Provider Name (Legal Business Name): H STREET CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 W MANCHESTER BLVD
INGLEWOOD CA
90305-2436
US

IV. Provider business mailing address

714 W OLYMPIC BLVD STE 801
LOS ANGELES CA
90015-1440
US

V. Phone/Fax

Practice location:
  • Phone: 323-778-4310
  • Fax: 323-778-0838
Mailing address:
  • Phone: 213-536-5815
  • Fax: 213-478-0172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: ELEANOR PEREZ
Title or Position: CAO
Credential:
Phone: 626-488-3111