Provider Demographics
NPI:1851847982
Name:SOUTH CENTRAL FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTH CENTRAL FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VELOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-908-4247
Mailing Address - Street 1:1109 E VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-3718
Mailing Address - Country:US
Mailing Address - Phone:323-908-4200
Mailing Address - Fax:
Practice Address - Street 1:1109 E VERNON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90011-3718
Practice Address - Country:US
Practice Address - Phone:323-908-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH CENTRAL FAMILY HEALTH CENTER PHARMACY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-29
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY 53347333600000X, 3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy