Provider Demographics
NPI:1881764322
Name:SOUTHERN CALIFORNIA UNIVERSITY OF HEALTH SCIENCES
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA UNIVERSITY OF HEALTH SCIENCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:NAGARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-947-3386
Mailing Address - Street 1:16200 E AMBER VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604
Mailing Address - Country:US
Mailing Address - Phone:562-947-8755
Mailing Address - Fax:562-902-3332
Practice Address - Street 1:16200 E AMBER VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604
Practice Address - Country:US
Practice Address - Phone:562-947-8755
Practice Address - Fax:562-902-3332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWDC3371CMedicare PIN
CAWDC3371BMedicare PIN