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General NPI Number Information
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NPI Number | 1265343107
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Entity Type | Organization
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Legal Business Name | BOYS & GIRLS CLUBS COMMUNITY HEALTH SERVICES
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Dates
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Enumeration Date | 09/16/2026
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Last Update Date | 09/16/2026
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Provider Practice Location Address
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Address Line | 13645 CLINTON ST
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City | GARDEN GROVE
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State | CA
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Zip | 92843-4110
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Country | US
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Telephone | 714-530-0430
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Fax |
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Provider Business Mailing Address
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Address Line | 10540 CHAPMAN AVE
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City | GARDEN GROVE
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State | CA
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Zip | 92840-3101
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Country | US
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Telephone | 714-530-0430
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT COMMUNITY IMPACT
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Name | CHRISTINA SEPULVEDA
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Credential |
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Telephone | 714-852-1616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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