Provider Demographics
NPI:1588937148
Name:CALIFORNIA HISPANIC COMMISSION ON ALCOHOL AND DRUG ABUSE
Entity type:Organization
Organization Name:CALIFORNIA HISPANIC COMMISSION ON ALCOHOL AND DRUG ABUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAM SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-443-5473
Mailing Address - Street 1:3514 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-1541
Mailing Address - Country:US
Mailing Address - Phone:323-721-9213
Mailing Address - Fax:
Practice Address - Street 1:3514 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-1541
Practice Address - Country:US
Practice Address - Phone:323-721-9213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA190065MNOtherDRUG MEDI-CAL