Healthcare Provider Details

I. General information

NPI: 1447353701
Provider Name (Legal Business Name): ARROYO VISTA FAMILY HEALTH FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 N FIGUEROA STREET
LOS ANGELES CA
90042-4232
US

IV. Provider business mailing address

6000 N FIGUEROA STREET
LOS ANGELES CA
90042-4232
US

V. Phone/Fax

Practice location:
  • Phone: 323-254-5291
  • Fax: 323-254-4618
Mailing address:
  • Phone: 323-254-5291
  • Fax: 323-254-4618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number960001394
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. LORRAINE ESTRADAS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.P.H., RN
Phone: 323-254-5291