Healthcare Provider Details

I. General information

NPI: 1073043204
Provider Name (Legal Business Name): AIDS HEALTHCARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 BORDER VILLAGE RD STE K
SAN YSIDRO CA
92173-3154
US

IV. Provider business mailing address

18421 S MAIN ST
GARDENA CA
90248-4609
US

V. Phone/Fax

Practice location:
  • Phone: 619-428-3760
  • Fax:
Mailing address:
  • Phone: 310-999-6089
  • Fax: 833-261-3712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: KENNETH SCOTT CARRUTHERS
Title or Position: CHIEF PHARMACY OFFICER
Credential:
Phone: 323-860-5200