Provider Demographics
NPI:1750711586
Name:FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC
Entity type:Organization
Organization Name:FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:MR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:N
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:562-587-3635
Mailing Address - Street 1:6501 S. GAFIELD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BELL GARDENS
Mailing Address - State:CA
Mailing Address - Zip Code:90201
Mailing Address - Country:US
Mailing Address - Phone:562-928-9600
Mailing Address - Fax:562-927-8603
Practice Address - Street 1:6513 S. GAFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-1815
Practice Address - Country:US
Practice Address - Phone:562-928-9600
Practice Address - Fax:562-927-8603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23236261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)