| |
711 W Florence Ave Los Angeles CA 90044-6105 | |
(323) 789-5610 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 711 W Florence Ave, Los Angeles, California |
Authorized Official Name and Position | Alfredo Reynoso (CHIEF OPERATING OFFICER) |
Authorized Official Contact | 3233135588 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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711 W Florence Ave Los Angeles CA 90044-6105 Ph: (323) 789-5610 | 711 W Florence Ave Los Angeles CA 90044-6105 Ph: (323) 789-5610 |
NPI Number | 1114638723 |
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Provider Enumeration Date | 12/06/2022 |
Last Update Date | 05/23/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114638723 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Secondary |
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
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