Provider Demographics
NPI:1821302027
Name:ARROYO VISTA FAMILY HEALTH FOUNDATION
Entity Type:Organization
Organization Name:ARROYO VISTA FAMILY HEALTH FOUNDATION
Other - Org Name:ARROYO VISTA FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADAS
Authorized Official - Suffix:
Authorized Official - Credentials:RN MPH
Authorized Official - Phone:323-254-5291
Mailing Address - Street 1:6000 N FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-4232
Mailing Address - Country:US
Mailing Address - Phone:323-254-5291
Mailing Address - Fax:323-254-4618
Practice Address - Street 1:4837 HUNTINGTON DR N
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90032-1981
Practice Address - Country:US
Practice Address - Phone:323-225-0024
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW6070OtherMEDICARE PIN
CA551140OtherMEDICARE OSCAR/CERTIFICATION