Organization
ST. JUDE HOSPITAL, INC.
Active
Other names
St. Jude Mobile Family Health Clinic 2
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARRY ROSS RN (VICE PRESIDENT, HEALTHY COMMUNITIES)
(714) 992-3164
Entity
Organization
Contact information
Practice address
731 SOUTH HIGHLAND AVENUE, FULLERTON, CA 92832
(714) 446-5100
Mailing address
731 SOUTH HIGHLAND AVENUE, FULLERTON, CA 92832
(714) 446-5100
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CMM 70905F
—
CA
Enumeration date
04/06/2007
Last updated
08/22/2020
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