Provider Demographics
NPI:1396235883
Name:SAN JUDAS COMMUNITY HEALTH CENTER, INC
Entity type:Organization
Organization Name:SAN JUDAS COMMUNITY HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:NEJAT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSTAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-780-4674
Mailing Address - Street 1:1080 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2310
Mailing Address - Country:US
Mailing Address - Phone:213-484-0000
Mailing Address - Fax:213-387-0011
Practice Address - Street 1:2972 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1101
Practice Address - Country:US
Practice Address - Phone:213-484-0000
Practice Address - Fax:213-387-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center