Provider Demographics
NPI:1326198847
Name:COLLEGE HEALTH IPA
Entity Type:Organization
Organization Name:COLLEGE HEALTH IPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:562-467-5530
Mailing Address - Street 1:17100 PIONEER BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90701-2754
Mailing Address - Country:US
Mailing Address - Phone:562-467-5419
Mailing Address - Fax:562-467-5400
Practice Address - Street 1:17100 PIONEER BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90701-2754
Practice Address - Country:US
Practice Address - Phone:562-467-5419
Practice Address - Fax:562-467-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty