Healthcare Provider Details

I. General information

NPI: 1447233358
Provider Name (Legal Business Name): AIDS HEALTHCARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8263 GROVE AVE STE 201
RANCHO CUCAMONGA CA
91730-3107
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 909-579-0708
  • Fax:
Mailing address:
  • Phone: 323-860-5200
  • Fax: 833-241-7615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number240000875
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYLE HONIG MOJICA
Title or Position: CFO
Credential:
Phone: 323-860-5305