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General NPI Number Information
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NPI Number | 1689181331
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Entity Type | Organization
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Legal Business Name | SOUTHLAND INTEGRATED SERVICES, INC.
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Dates
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Enumeration Date | 01/03/2018
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Last Update Date | 03/05/2018
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Provider Practice Location Address
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Address Line | 14140 BEACH BLVD STE 223
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City | WESTMINSTER
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State | CA
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Zip | 92683-4453
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Country | US
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Telephone | 714-934-4637
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Fax |
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Provider Business Mailing Address
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Address Line | 14140 BEACH BLVD STE 223
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City | WESTMINSTER
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State | CA
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Zip | 92683-4453
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Country | US
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Telephone | 714-934-4637
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | TRICIA THAO NGUYEN
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Credential | M.P.H
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Telephone | 714-620-7007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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