Healthcare Provider Details

I. General information

NPI: 1376798413
Provider Name (Legal Business Name): ASIAN AND PACIFIC ISLANDER WELLNESS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 POLK ST 4TH FLOOR
SAN FRANCISCO CA
94109
US

IV. Provider business mailing address

726 POLK ST 4TH FLOOR
SAN FRANCISCO CA
94109
US

V. Phone/Fax

Practice location:
  • Phone: 415-292-3400
  • Fax: 415-292-3404
Mailing address:
  • Phone: 415-292-3400
  • Fax: 415-292-3404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number550001294
License Number StateCA

VIII. Authorized Official

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