Provider Demographics
NPI:1033254024
Name:THE CHILDRENS CLINIC 'SERVING CHILDREN AND THEIR FAMILIES'
Entity Type:Organization
Organization Name:THE CHILDRENS CLINIC 'SERVING CHILDREN AND THEIR FAMILIES'
Other - Org Name:TCC AT INTERNATIONAL ELEMENTARY SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATION OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAWLER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:562-264-3985
Mailing Address - Street 1:701 E 28TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2759
Mailing Address - Country:US
Mailing Address - Phone:562-264-4694
Mailing Address - Fax:
Practice Address - Street 1:700 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4317
Practice Address - Country:US
Practice Address - Phone:562-264-4694
Practice Address - Fax:562-436-6210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC11466FMedicaid
CA05-1112Medicare PIN