Provider Demographics
NPI:1386082766
Name:ESTEBAN E. TORRES HIGH SCHOOL CLINIC
Entity type:Organization
Organization Name:ESTEBAN E. TORRES HIGH SCHOOL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JACOBUS
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DER COLFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-785-5923
Mailing Address - Street 1:316 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-3504
Mailing Address - Country:US
Mailing Address - Phone:213-785-5922
Mailing Address - Fax:213-785-5914
Practice Address - Street 1:4127 EAST CESAR CHAVEZ AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063
Practice Address - Country:US
Practice Address - Phone:323-265-6701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIENVENIDOS CHILDREN'S CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA960001182261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health