Provider Demographics
NPI:1457116709
Name:H STREET CLINIC
Entity Type:Organization
Organization Name:H STREET CLINIC
Other - Org Name:CENTRAL NEIGHBORHOOD HEALTH FOUNDATION - WILSHIRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-381-0803
Mailing Address - Street 1:2700 S GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3301
Mailing Address - Country:US
Mailing Address - Phone:213-536-5814
Mailing Address - Fax:
Practice Address - Street 1:1245 WILSHIRE BLVD STE 715
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4807
Practice Address - Country:US
Practice Address - Phone:213-643-3170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:H STREET CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-02-15
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)