NPIMap

Organization Active NPI

State of California - Department of Developmental Services

Doing business as Lanterman Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Pomona, CA
National Provider Identifier
1093085565
Registry record updated Jan 17, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
STATE OF CALIFORNIA - DEPARTMENT OF DEVELOPMENTAL SERVICES
Doing business as
Lanterman Community Clinic
Practice address
3530 W Pomona Blvd
Pomona, CA 91768-3238
Phone
(909) 444-7000
NPI assigned
Dec 30, 2011
Last updated
Jan 17, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mark Hutchinson
Title
Deputy Director
Phone
(916) 654-1897

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X CA Primary

Addresses

Primary practice location

3530 W Pomona Blvd
Pomona, CA 91768-3238

Mailing address

1600 9TH St Ste 205
Ms 2-3
Sacramento, CA 95814-6435
Phone (916) 654-2431

Other names 1

  • Lanterman Community Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Agnews Community Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3530 Pomona Blvd
Pomona, CA 91768
Phone (909) 444-7200

1600 9th St
Ste 205
Sacramento, CA 95814

Practitioners & affiliated clinicians

Practitioners 311

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 311

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325203200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326758400000",
    "number": "1093085565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 9TH ST STE 205",
            "address_2": "MS 2-3",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958146435",
            "telephone_number": "916-654-2431",
            "fax_number": "916-653-4587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3530 W POMONA BLVD",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917683238",
            "telephone_number": "909-444-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF CALIFORNIA - DEPARTMENT OF DEVELOPMENTAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-30",
        "last_updated": "2012-01-17",
        "status": "A",
        "authorized_official_last_name": "HUTCHINSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DEPUTY DIRECTOR",
        "authorized_official_telephone_number": "916-654-1897",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lanterman Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.