Provider Demographics
NPI:1720468804
Name:PEDIATRIC AND FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:PEDIATRIC AND FAMILY MEDICAL CENTER
Other - Org Name:EISNER PEDIATRIC AND FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VP, COO & INTERIM-CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-747-5542
Mailing Address - Street 1:1513 S GRAND AVE
Mailing Address - Street 2:SUITE 220 & 250
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3070
Mailing Address - Country:US
Mailing Address - Phone:213-747-5542
Mailing Address - Fax:
Practice Address - Street 1:1513 S GRAND AVE
Practice Address - Street 2:SUITE 220 & 250
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3070
Practice Address - Country:US
Practice Address - Phone:213-747-5542
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)