Provider Demographics
NPI:1821777269
Name:LA ISLA FAMILY & FRIENDS CORPORATION
Entity Type:Organization
Organization Name:LA ISLA FAMILY & FRIENDS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-924-8637
Mailing Address - Street 1:2332 HOFFMAN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-8003
Mailing Address - Country:US
Mailing Address - Phone:646-924-8637
Mailing Address - Fax:914-840-1180
Practice Address - Street 1:2332 HOFFMAN ST FL 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-8003
Practice Address - Country:US
Practice Address - Phone:646-924-8637
Practice Address - Fax:914-840-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care