| Organization Name: | CHC IMMUNIZATION AND TRAVEL HEALTH CENTER |
| NPI Number: | 1053684662 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NELIA PASUMBAL BLANCO (PRESIDENT) |
| Mailing Address: | 5 Windsor Avenue Suite 1 Upper Darby |
| State: | PA US |
| Postal Code: | 190822727 |
| Phone Number: | 6108531085 |
| Fax Number: | 6108536799 |
| NPI Enumeration Date: | 02/13/2012 |
| NPI Last Update Date: | 02/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |