Healthcare Provider Details

I. General information

NPI: 1922489665
Provider Name (Legal Business Name): FRIENDS OF FAMILY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13152 NEWPORT AVE SUITE B
TUSTIN CA
92780-3469
US

IV. Provider business mailing address

501 S IDAHO ST 260
LA HABRA CA
90631-6047
US

V. Phone/Fax

Practice location:
  • Phone: 714-263-8600
  • Fax: 714-263-8601
Mailing address:
  • Phone: 562-690-0400
  • Fax: 562-501-1198

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: DAWN TA
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 562-690-0400