Provider Demographics
NPI:1063028314
Name:TRANSGENDER HEALTH AND WELLNESS CENTER
Entity Type:Organization
Organization Name:TRANSGENDER HEALTH AND WELLNESS CENTER
Other - Org Name:TRANSGENDER HEALTH AND WELLNESS CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:760-202-4308
Mailing Address - Street 1:6840 INDIANA AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-4271
Mailing Address - Country:US
Mailing Address - Phone:760-202-4308
Mailing Address - Fax:
Practice Address - Street 1:6840 INDIANA AVE STE 150
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-4271
Practice Address - Country:US
Practice Address - Phone:760-202-4308
Practice Address - Fax:760-818-8025
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRANSGENDER HEALTH AND WELLNESS CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-22
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty