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General NPI Number Information
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NPI Number | 1215293733
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Entity Type | Organization
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Legal Business Name | QUEENSCARE HEALTH ALLIANCE
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 680 LITTLE ST
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City | LOS ANGELES
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State | CA
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Zip | 90017-1644
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Country | US
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Telephone | 237-151-5273
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Fax |
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Provider Business Mailing Address
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Address Line | 950 S GRAND AVE FL 2
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City | LOS ANGELES
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State | CA
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Zip | 90015-3999
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Country | US
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Telephone | 323-669-4346
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Fax | 323-953-2757
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | BARBARA B. HINES
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Credential |
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Telephone | 323-669-4302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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