NPIMap

Organization Active NPI

The Childrens Clinic 'Serving Children and Their Families'

  • Community Health Clinic/Center
  • Long Beach, CA
National Provider Identifier
1275917692
Registry record updated May 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
THE CHILDRENS CLINIC 'SERVING CHILDREN AND THEIR FAMILIES'
Practice address
2000 San Gabriel Avenue
Long Beach, CA 90810
Phone
(562) 264-4600
Fax
(562) 216-6190
NPI assigned
Jul 15, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 1, 2023

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

Authorized official

Name
Jina Lawler, MSW
Title
Chief Operations Officer
Phone
(562) 264-3985

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X CA Primary
Federally Qualified Health Center (FQHC) 261QF0400X CA

Addresses

Primary practice location

2000 San Gabriel Avenue
Long Beach, CA 90810

Mailing address

701 E 28TH St
Suite 200
Long Beach, CA 90806-2759
Phone (562) 264-3985

Other names 1

  • The Children's Clinic Family Health Center Cabrillo Gateway Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161212002361 CA Part A Provider - Federally Qualified Health Center (FQHC) 3870544919 Practice locations: Long Beach, CA

Federally qualified health center certification: CCN 751941

Legal name
THE CHILDREN'S CLINIC SERVING CHILDREN AND THEIR FAMILIES
Doing business as
THE CHILDREN'S CLINIC FAMILY HEALTH CENTER CABRILLO GATEWAY
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 18, 2016
Last certification
Nov 18, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 16, 1939 in CA
Enrollment address
2000 San Gabriel Ave
Long Beach, CA 90810-3601

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2103232Children'S Clinic, the2000 San Gabriel Ave, Long Beach, CA 90810Certificate of waiverOct 7, 2027

National Provider Directory

National Provider Directory
Tax ID family
The Children'S Clinic Serving Children and Their Families17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Cesar Vazquez Individual Corporate DirectorDirector of Operations Nov 1, 2023
W-2 Managing EmployeeDirector of Operations Nov 1, 2023
Operational/Managerial ControlDirector of Operations Nov 1, 2023
Harold Milton Vandyke Individual Corporate OfficerBoard President Jan 1, 2010 100%
Andrew Horvath Individual Corporate DirectorChief Information Officer Aug 24, 2015
W-2 Managing EmployeeChief Information Officer Aug 24, 2015
Operational/Managerial ControlChief Information Officer Aug 24, 2015
Maria Chandler Individual Corporate DirectorChief Medical Officer Aug 24, 2015
W-2 Managing EmployeeChief Medical Officer Aug 24, 2015
Elisa Nicholas Individual Corporate DirectorChief Executive Officer Jul 1, 1988 100%
W-2 Managing EmployeeChief Executive Officer Jul 1, 1988 100%

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682899200000",
    "number": "1275917692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 E 28TH ST",
            "address_2": "SUITE 200",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062759",
            "telephone_number": "562-264-3985",
            "fax_number": "562-216-6197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 SAN GABRIEL AVENUE",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "90810",
            "telephone_number": "562-264-4600",
            "fax_number": "562-216-6190"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHILDRENS CLINIC 'SERVING CHILDREN AND THEIR FAMILIES'",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-15",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A",
        "authorized_official_last_name": "LAWLER",
        "authorized_official_first_name": "JINA",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "562-264-3985",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Children's Clinic Family Health Center Cabrillo Gateway",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Children's Clinic Family Health Center Cabrillo Gateway",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Long Beach, CA

Sources for this page

Verify at the official NPI Registry.