Healthcare Provider Details

I. General information

NPI: 1568021772
Provider Name (Legal Business Name): ST. JUDE NEIGHBORHOOD HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1934 E TAFT AVE
ORANGE CA
92865-4702
US

IV. Provider business mailing address

731 S HIGHLAND AVE
FULLERTON CA
92832-2753
US

V. Phone/Fax

Practice location:
  • Phone: 714-771-8006
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY JASON BROWN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 208-899-9631