Provider Demographics
NPI:1679267231
Name:VIA CARE COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:VIA CARE COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-268-9191
Mailing Address - Street 1:3601 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-2325
Mailing Address - Country:US
Mailing Address - Phone:323-268-9191
Mailing Address - Fax:323-268-9119
Practice Address - Street 1:5800 FULTON AVE
Practice Address - Street 2:SUITE 121 STUDENT UNION
Practice Address - City:VALLEY GLEN
Practice Address - State:CA
Practice Address - Zip Code:91401-4062
Practice Address - Country:US
Practice Address - Phone:323-268-9191
Practice Address - Fax:323-268-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)