1902155187 NPI number — FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC.

Table of content: (NPI 1902155187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902155187 NPI number — FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902155187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6501 GARFIELD AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELL GARDENS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90201-1805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-928-9600
Provider Business Mailing Address Fax Number:
562-907-8603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MINES AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEBELLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-201-4820
Provider Business Practice Location Address Fax Number:
323-201-4864
Provider Enumeration Date:
09/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NUNEZ
Authorized Official First Name:
FELIX
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
562-928-9600

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  219507 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com