Provider Demographics
NPI:1356629083
Name:FOOTHILL AIDS PROJECT
Entity Type:Organization
Organization Name:FOOTHILL AIDS PROJECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:
Authorized Official - Last Name:TONA-AREVALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-482-2066
Mailing Address - Street 1:233 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4324
Mailing Address - Country:US
Mailing Address - Phone:909-482-2066
Mailing Address - Fax:909-482-2070
Practice Address - Street 1:233 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4324
Practice Address - Country:US
Practice Address - Phone:909-482-2066
Practice Address - Fax:909-482-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC-1411314OtherSTATE REGISTRATION