Provider Demographics
NPI:1942694096
Name:MISSION CITY COMMUNITY NETWORK, INC.
Entity Type:Organization
Organization Name:MISSION CITY COMMUNITY NETWORK, INC.
Other - Org Name:MISSION CITY COMMUNITY NETWORK, INC.-LA PUENTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-895-3100
Mailing Address - Street 1:15206 PARTHENIA ST
Mailing Address - Street 2:
Mailing Address - City:NORTH HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91343-5305
Mailing Address - Country:US
Mailing Address - Phone:818-895-3100
Mailing Address - Fax:818-893-9464
Practice Address - Street 1:1025 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-1617
Practice Address - Country:US
Practice Address - Phone:818-895-3100
Practice Address - Fax:818-893-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center