Provider Demographics
NPI:1699014480
Name:CENTER OF HOPE HEALTH & WELLNESS CENTER
Entity Type:Organization
Organization Name:CENTER OF HOPE HEALTH & WELLNESS CENTER
Other - Org Name:CENTER OF HOPE
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA-MITU
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, NP
Authorized Official - Phone:310-347-2686
Mailing Address - Street 1:2707 W TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4723
Mailing Address - Country:US
Mailing Address - Phone:310-347-2686
Mailing Address - Fax:866-372-7824
Practice Address - Street 1:2707 W TEMPLE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4723
Practice Address - Country:US
Practice Address - Phone:310-347-2686
Practice Address - Fax:866-372-7824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care