Provider Demographics
NPI:1013174945
Name:EAST LOS ANGELES HEALTH TASK FORCE
Entity type:Organization
Organization Name:EAST LOS ANGELES HEALTH TASK FORCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SUSANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARELLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-261-2171
Mailing Address - Street 1:2120 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-1202
Mailing Address - Country:US
Mailing Address - Phone:323-261-2171
Mailing Address - Fax:
Practice Address - Street 1:2120 EAST 6TH STREET
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-1202
Practice Address - Country:US
Practice Address - Phone:323-261-2171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960000237251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEAP00002FOtherEAPC