Provider Demographics
NPI:1700912557
Name:CHILDREN'S BUREAU OF SOUTHERN CALIFORNIA
Entity type:Organization
Organization Name:CHILDREN'S BUREAU OF SOUTHERN CALIFORNIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:QA ADMINISTRATIVE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LETICIA
Authorized Official - Middle Name:H
Authorized Official - Last Name:JUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-342-0150
Mailing Address - Street 1:1515 W CAMERON AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2726
Mailing Address - Country:US
Mailing Address - Phone:626-337-8811
Mailing Address - Fax:626-856-5653
Practice Address - Street 1:1515 W CAMERON AVE STE 350
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2726
Practice Address - Country:US
Practice Address - Phone:626-337-8811
Practice Address - Fax:626-856-5653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7302AOtherDMH REPORTING UNIT
CA00007302Medicaid
CA00668OtherDMH LEGAL ENITITY NUMBER