Healthcare Provider Details

I. General information

NPI: 1962566265
Provider Name (Legal Business Name): THE CHILDRENS CLINIC 'SERVING CHILDREN AND THEIR FAMILIES'
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W 3RD ST
LONG BEACH CA
90802-2745
US

IV. Provider business mailing address

701 E 28TH ST SUITE 200
LONG BEACH CA
90806-2759
US

V. Phone/Fax

Practice location:
  • Phone: 562-264-4822
  • Fax: 562-435-5034
Mailing address:
  • Phone: 562-264-3985
  • Fax: 562-216-6197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number960001459
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: JINA L. LAWLER
Title or Position: CHIEF OPERATIONS OFFICER
Credential: MSW
Phone: 562-264-3985