Healthcare Provider Details

I. General information

NPI: 1902880479
Provider Name (Legal Business Name): AIDS HEALTHCARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4905 HOLLYWOOD BLVD
LOS ANGELES CA
90027-6101
US

IV. Provider business mailing address

6255 W SUNSET BLVD
LOS ANGELES CA
90028-7403
US

V. Phone/Fax

Practice location:
  • Phone: 323-662-0492
  • Fax:
Mailing address:
  • Phone: 323-860-5200
  • Fax: 833-241-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number960001126
License Number StateCA

VIII. Authorized Official

Name: LYLE HONIG MOJICA
Title or Position: CFO
Credential:
Phone: 323-860-5305