Healthcare Provider Details

I. General information

NPI: 1457116709
Provider Name (Legal Business Name): H STREET CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD STE 715
LOS ANGELES CA
90017-4807
US

IV. Provider business mailing address

2700 S GRAND AVE
LOS ANGELES CA
90007-3301
US

V. Phone/Fax

Practice location:
  • Phone: 213-643-3170
  • Fax:
Mailing address:
  • Phone: 213-536-5814
  • 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: ELEANOR PEREZ
Title or Position: CAO
Credential:
Phone: 909-381-0803