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General NPI Number Information
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NPI Number | 1942717699
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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 | 02/27/2019
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Provider Practice Location Address
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Address Line | 2035 E BALL RD STE 100A
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City | ANAHEIM
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State | CA
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Zip | 92806-5158
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Country | US
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Telephone | 714-517-6150
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Fax |
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Provider Business Mailing Address
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Address Line | 2035 E BALL RD
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City | ANAHEIM
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State | CA
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Zip | 92806-5159
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Country | US
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Telephone | 714-517-6150
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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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