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2469 Lincoln Blvd Venice CA 90291-5040 | |
(310) 392-8636 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 2469 Lincoln Blvd, Venice, California |
Authorized Official Name and Position | Mitesh G Popat (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 3106647901 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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604 Rose Ave Venice CA 90291-2767 Ph: (310) 392-8636 | 2469 Lincoln Blvd Venice CA 90291-5040 Ph: (310) 392-8636 |
NPI Number | 1053854836 |
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Provider Enumeration Date | 11/28/2016 |
Last Update Date | 09/11/2023 |
Medicare PECOS PAC ID | 2264339126 |
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Medicare Enrollment ID | O20170116000514 |
Identifier | Type | State | Issuer |
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1053854836 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Venice Family Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 622 Rose Ave, Venice, CA 90291 Phone: 310-392-8636 | |