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2655 W. Olympic Blvd., Los Angeles CA 90006-2810 | |
(818) 895-3100 | |
(818) 893-9464 |
Full Name | |
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Speciality | Clinic/center - Federally Qualified Health Center (fqhc) |
Location | 2655 W. Olympic Blvd.,, Los Angeles, California |
Authorized Official Name and Position | Nik Gupta (CEO) |
Authorized Official Contact | 8188953100 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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8527 Sepulveda Blvd North Hills CA 91343-5824 Ph: (818) 895-3100 | 2655 W. Olympic Blvd., Los Angeles CA 90006-2810 Ph: (818) 895-3100 |
NPI Number | 1992246979 |
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Provider Enumeration Date | 03/10/2017 |
Last Update Date | 03/14/2017 |
Identifier | Type | State | Issuer |
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1992246979 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 960001162 (California) | Primary |
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