Healthcare Provider Details

I. General information

NPI: 1689070716
Provider Name (Legal Business Name): ST. JUDE NEIGHBORHOOD HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 N SULLIVAN ST
SANTA ANA CA
92703-3416
US

IV. Provider business mailing address

731 S HIGHLAND AVE
FULLERTON CA
92832-2753
US

V. Phone/Fax

Practice location:
  • Phone: 714-771-8005
  • Fax: 714-744-8629
Mailing address:
  • Phone: 714-446-5100
  • Fax: 714-744-8629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

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