Provider Demographics
NPI:1700530938
Name:UNIFIEDCARE COMMUNITY HEALTH CENTER A CALIFORNIA NONPROFIT ORGANIZATIO
Entity Type:Organization
Organization Name:UNIFIEDCARE COMMUNITY HEALTH CENTER A CALIFORNIA NONPROFIT ORGANIZATIO
Other - Org Name:UNIFIEDCARE COMMUNITY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:P
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:424-457-7012
Mailing Address - Street 1:2040 PACIFIC COAST HWY STE S
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-2660
Mailing Address - Country:US
Mailing Address - Phone:424-457-7012
Mailing Address - Fax:844-481-9664
Practice Address - Street 1:2040 PACIFIC COAST HWY STE S
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2660
Practice Address - Country:US
Practice Address - Phone:424-347-8008
Practice Address - Fax:844-481-9664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-07
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)