MEDICARE: BIENVENIDOS CHILDREN'S CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417089046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIENVENIDOS CHILDREN'S CENTER, INC

Provider Business Mailing Address
First Line	:	501 S ATLANTIC BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2621
Country	:	US
Telephone Number	:	213-785-5906
Fax Number	:	213-785-5928

Provider Business Practice Location Address
First Line	:	255 N SAN GABRIEL BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-3429
Country	:	US
Telephone Number	:	626-696-1270
Fax Number	:

Authorized Official
Title or Position	:	CHIEF PROGRAM OFFICER
Name	:	MS. MIRIAM GONZALEZ
Credential	:	MA
Telephone Number	:	213-785-5906

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	03/09/2016

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