| NPI | 1609486869 |
|---|---|
| Doing Business As | JWCH PATH CLINIC |
| Entity Type | Organization |
| Authorized Contact | ALVARO PROSPERO BALLESTEROS Chief Executive Officer 323-201-4516 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2020-08-03 |