| Mission City Community Network, Inc. | |
|
8363 Reseda Blvd Ste 11 Northridge CA 91324-4694 | |
| (818) 998-7085 | |
| (818) 998-3579 |
| Full Name | Mission City Community Network, Inc. |
|---|---|
| Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
| Location | 8363 Reseda Blvd Ste 11, Northridge, California |
| Authorized Official Name and Position | Nik Gupta (CHEIF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8188953100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mission City Community Network, Inc. 8527 Sepulveda Blvd North Hills CA 91343-5824 Ph: (818) 895-3100 | Mission City Community Network, Inc. 8363 Reseda Blvd Ste 11 Northridge CA 91324-4694 Ph: (818) 998-7085 |
| NPI Number | 1275786402 |
|---|---|
| Provider Enumeration Date | 10/31/2008 |
| Last Update Date | 06/06/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275786402 | NPI | - | NPPES |
| EAP70436F | Other | CA | MEDICAL PROVIDER NUMBER |
| HAP70436F | Other | CA | MEDICAL PROVIDER NUMBER |
| FHC70436F | Other | CA | MEDICAL PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 550000351 (California) | Primary |
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