Provider Demographics
NPI:1447872577
Name:H STREET CLINIC
Entity type:Organization
Organization Name:H STREET CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
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:951-774-3050
Mailing Address - Street 1:714 W OLYMPIC BLVD STE 801
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1440
Mailing Address - Country:US
Mailing Address - Phone:213-536-5815
Mailing Address - Fax:213-478-0172
Practice Address - Street 1:3750 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2607
Practice Address - Country:US
Practice Address - Phone:951-774-3050
Practice Address - Fax:951-774-3182
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:H STREET CLINIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-12
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)