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General NPI Number Information
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NPI Number | 1922280742
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Entity Type | Organization
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Legal Business Name | CHICANOS POR LA CAUSA, INC.
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 03/17/2011
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Provider Practice Location Address
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Address Line | 106 E. 1ST STREET
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City | YUMA
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State | AZ
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Zip | 85364
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Country | US
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Telephone | 928-343-9825
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Fax | 925-343-9803
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Provider Business Mailing Address
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Address Line | 1112 E. BUCKEYE RD.
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City | PHOENIX
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State | AZ
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Zip | 85034
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Country | US
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Telephone | 602-257-0700
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Fax | 602-307-9752
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Authorized Official
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Title or Position | CEO
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Name | MR. EDMUNDO HIDALGO
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Credential |
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Telephone | 602-257-0700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | BH-2684
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License Number State | AZ
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