Provider Demographics
NPI:1689796112
Name:CHICANOS POR LA CAUSA
Entity Type:Organization
Organization Name:CHICANOS POR LA CAUSA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-882-0018
Mailing Address - Street 1:200 N STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-1208
Mailing Address - Country:US
Mailing Address - Phone:520-882-0018
Mailing Address - Fax:520-882-9007
Practice Address - Street 1:200 N STONE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-1208
Practice Address - Country:US
Practice Address - Phone:520-882-0018
Practice Address - Fax:520-882-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health