Provider Demographics
NPI:1518066299
Name:CHILDREN'S HOSPITAL LOS ANGELES MENTAL HEALTH
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL LOS ANGELES MENTAL HEALTH
Other - Org Name:CHILDREN'S HOSPITAL LA- QUEENSCARE HEALTH AND FAITH PARTNERSHIP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:LUCIA
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:323-669-4355
Mailing Address - Street 1:950 S GRAND AVE
Mailing Address - Street 2:2ND FLOOR SOUTH
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-4202
Mailing Address - Country:US
Mailing Address - Phone:323-669-4302
Mailing Address - Fax:323-906-0143
Practice Address - Street 1:4618 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029
Practice Address - Country:US
Practice Address - Phone:323-669-4355
Practice Address - Fax:323-953-7300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health