Provider Demographics
NPI:1871933945
Name:SOUTH BAY FAMILY HEALTHCARE CENTER
Entity type:Organization
Organization Name:SOUTH BAY FAMILY HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-802-6177
Mailing Address - Street 1:23430 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4720
Mailing Address - Country:US
Mailing Address - Phone:310-802-6177
Mailing Address - Fax:310-802-6178
Practice Address - Street 1:270 E 223RD ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-3804
Practice Address - Country:US
Practice Address - Phone:310-802-6177
Practice Address - Fax:310-802-6178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-03
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)