Provider Demographics
NPI:1558981381
Name:BLESSING COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:BLESSING COMMUNITY HEALTH CENTER
Other - Org Name:BLESSING COMMUNITY HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GITA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINLOO
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:714-878-5522
Mailing Address - Street 1:12155 WYNE CT
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1185
Mailing Address - Country:US
Mailing Address - Phone:714-878-5522
Mailing Address - Fax:949-341-5522
Practice Address - Street 1:3972 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-1700
Practice Address - Country:US
Practice Address - Phone:909-433-9700
Practice Address - Fax:949-341-5522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty