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General NPI Number Information
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NPI Number | 1376929828
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Entity Type | Organization
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Legal Business Name | ST ANTOINE DE PADOUE HEALTH CLINIC CORP.
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 127 W 7TH ST
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City | LONG BEACH
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State | CA
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Zip | 90813-4344
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Country | US
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Telephone | 562-324-6901
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Fax | 562-977-5715
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Provider Business Mailing Address
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Address Line | 127 W 7TH ST
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City | LONG BEACH
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State | CA
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Zip | 90813-4344
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Country | US
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Telephone | 562-977-5715
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Fax | 562-977-5715
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Authorized Official
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Title or Position | CEO
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Name | BERGERETTE SAINT-VICTOR
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Credential | FNP
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Telephone | 562-977-5715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | BU21412090
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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