Provider Demographics
NPI:1376960971
Name:STUDENT HEALTH CENTER LA HARBOR COLLEGE
Entity Type:Organization
Organization Name:STUDENT HEALTH CENTER LA HARBOR COLLEGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HEALTH CENTER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:KING
Authorized Official - Last Name:STEVENSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:310-233-4520
Mailing Address - Street 1:1111 FIGUEROA PL
Mailing Address - Street 2:CAFE 110
Mailing Address - City:WILMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:90744-2311
Mailing Address - Country:US
Mailing Address - Phone:310-233-4520
Mailing Address - Fax:310-233-4055
Practice Address - Street 1:1111 FIGUEROA PL
Practice Address - Street 2:CAFE 110
Practice Address - City:WILMINGTON
Practice Address - State:CA
Practice Address - Zip Code:90744-2311
Practice Address - Country:US
Practice Address - Phone:310-233-4520
Practice Address - Fax:310-233-4055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOS ANGELES HARBOR COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA461288261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service