Healthcare Provider Details

I. General information

NPI: 1871818138
Provider Name (Legal Business Name): FRIENDS OF FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S IDAHO ST SUITE 100
LA HABRA CA
90631-6047
US

IV. Provider business mailing address

501 S IDAHO ST SUITE 100
LA HABRA CA
90631-6047
US

V. Phone/Fax

Practice location:
  • Phone: 562-690-0400
  • Fax: 562-690-3182
Mailing address:
  • Phone: 562-690-0400
  • Fax: 562-690-3182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA106562
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13382
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number50015
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA80057
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG51286
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA81700
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A9142
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number8539
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. DAWN TA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 562-690-0400