Healthcare Provider Details

I. General information

NPI: 1699509497
Provider Name (Legal Business Name): CHARITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4075 TWEEDY BLVD
SOUTH GATE CA
90280-6146
US

IV. Provider business mailing address

4075 TWEEDY BLVD
SOUTH GATE CA
90280-6146
US

V. Phone/Fax

Practice location:
  • Phone: 323-566-4111
  • Fax: 323-563-0439
Mailing address:
  • Phone: 323-566-4111
  • Fax: 323-563-0439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT AZURIN
Title or Position: CEO
Credential: MD
Phone: 323-566-4111