Provider Demographics
NPI:1821625872
Name:SOUTHERN CALIFORNIA MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-650-6700
Mailing Address - Street 1:PO BOX 436
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91408-0436
Mailing Address - Country:US
Mailing Address - Phone:818-421-0809
Mailing Address - Fax:909-620-5799
Practice Address - Street 1:502 W HOLT AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3604
Practice Address - Country:US
Practice Address - Phone:909-620-8500
Practice Address - Fax:909-620-5799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography