Healthcare Provider Details

I. General information

NPI: 1225734650
Provider Name (Legal Business Name): ASIAN AND PACIFIC ISLANDER WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 01/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 PINE ST
SAN FRANCISCO CA
94109-4720
US

IV. Provider business mailing address

730 POLK ST
SAN FRANCISCO CA
94109-7813
US

V. Phone/Fax

Practice location:
  • Phone: 415-292-3420
  • Fax:
Mailing address:
  • Phone: 415-253-1279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LANCE TOMA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LCSW
Phone: 415-292-3420