Healthcare Provider Details

I. General information

NPI: 1265379838
Provider Name (Legal Business Name): JWCH INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 SANTA MONICA BLVD STE 110
LOS ANGELES CA
90038-4089
US

IV. Provider business mailing address

5650 JILLSON ST
COMMERCE CA
90040-1482
US

V. Phone/Fax

Practice location:
  • Phone: 323-201-4516
  • Fax:
Mailing address:
  • Phone: 323-201-4516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ALVARO PROSPERO BALLESTEROS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 323-201-4516