Provider Demographics
NPI:1740051309
Name:LA FAMILIA SANA
Entity type:Organization
Organization Name:LA FAMILIA SANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JADE
Authorized Official - Middle Name:ESTHER
Authorized Official - Last Name:WEYMOUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:707-669-0289
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:
Mailing Address - City:CLOVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:95425
Mailing Address - Country:US
Mailing Address - Phone:707-669-0289
Mailing Address - Fax:
Practice Address - Street 1:233 N CLOVERDALE BLVD
Practice Address - Street 2:
Practice Address - City:CLOVERDALE
Practice Address - State:CA
Practice Address - Zip Code:95425
Practice Address - Country:US
Practice Address - Phone:770-669-0289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty