Provider Demographics
NPI:1558541771
Name:AMERICAN INDIAN HEALING CENTER, INC.
Entity Type:Organization
Organization Name:AMERICAN INDIAN HEALING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-693-4325
Mailing Address - Street 1:7630 PAINTER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2373
Mailing Address - Country:US
Mailing Address - Phone:562-693-4325
Mailing Address - Fax:562-693-1115
Practice Address - Street 1:7630 PAINTER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2373
Practice Address - Country:US
Practice Address - Phone:562-693-4325
Practice Address - Fax:562-693-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-05
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40075261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WNP9678AMedicare PIN
CAA48073Medicare UPIN