Provider Demographics
NPI:1215586367
Name:PEDIATRIC AND FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:PEDIATRIC AND FAMILY MEDICAL CENTER
Other - Org Name:EISNER HEALTH OPTOMETRY AT ENCINO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP, COO & INTERIM CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-747-5542
Mailing Address - Street 1:1530 S OLIVE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3023
Mailing Address - Country:US
Mailing Address - Phone:213-747-5542
Mailing Address - Fax:
Practice Address - Street 1:5400 BALBOA BLVD STE 131
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5204
Practice Address - Country:US
Practice Address - Phone:213-747-5542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC AND FAMILY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-10
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)