Healthcare Provider Details

I. General information

NPI: 1891615183
Provider Name (Legal Business Name): BIRMINGHAM COMMUNITY CHARTER HIGH SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17000 HAYNES ST
LAKE BALBOA CA
91406-5420
US

IV. Provider business mailing address

17000 HAYNES ST
LAKE BALBOA CA
91406-5420
US

V. Phone/Fax

Practice location:
  • Phone: 818-758-5200
  • Fax:
Mailing address:
  • Phone: 818-758-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE TORRES
Title or Position: CBO
Credential: TORRES
Phone: 818-758-5251