Healthcare Provider Details

I. General information

NPI: 1245416189
Provider Name (Legal Business Name): AIDS HEALTHCARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6255 W SUNSET BLVD SUITE 2100
LOS ANGELES CA
90028-7403
US

IV. Provider business mailing address

6255 W SUNSET BLVD FL 21
LOS ANGELES CA
90028-7422
US

V. Phone/Fax

Practice location:
  • Phone: 323-860-5200
  • Fax: 323-962-8513
Mailing address:
  • Phone: 323-860-5200
  • Fax: 833-241-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DONNA STIDHAM
Title or Position: CHIEF OF MANAGED CARE
Credential:
Phone: 323-436-5025