Provider Demographics
NPI:1568672640
Name:STRAIGHT TALK CLINIC, INC
Entity Type:Organization
Organization Name:STRAIGHT TALK CLINIC, INC
Other - Org Name:STRAIGHT TALK CLINIC, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CONE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-828-2000
Mailing Address - Street 1:13710 LA MIRADA BLVD
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-3028
Mailing Address - Country:US
Mailing Address - Phone:562-943-0195
Mailing Address - Fax:562-943-4015
Practice Address - Street 1:13710 LA MIRADA BLVD
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-3028
Practice Address - Country:US
Practice Address - Phone:562-943-0195
Practice Address - Fax:562-943-4015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ41951ZOtherBLUESHIELD OF CA
CA=========OtherEIN