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General NPI Number Information
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NPI Number | 1689070716
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Entity Type | Organization
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Legal Business Name | ST. JUDE NEIGHBORHOOD HEALTH CENTERS
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Dates
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Enumeration Date | 11/18/2014
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Last Update Date | 08/10/2022
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Provider Practice Location Address
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Address Line | 280 N SULLIVAN ST
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City | SANTA ANA
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State | CA
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Zip | 92703-3416
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Country | US
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Telephone | 714-771-8005
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Fax | 714-744-8629
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Provider Business Mailing Address
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Address Line | 731 S HIGHLAND AVE
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City | FULLERTON
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State | CA
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Zip | 92832-2753
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Country | US
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Telephone | 714-446-5100
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Fax | 714-744-8629
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | TIMOTHY JASON BROWN
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Credential |
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Telephone | 208-899-9631
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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