Provider Demographics
NPI:1982063939
Name:SOUTH CENTRAL FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTH CENTRAL FAMILY HEALTH CENTER
Other - Org Name:CUDAHY FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
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 1:4425 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-3629
Mailing Address - Country:US
Mailing Address - Phone:323-908-4247
Mailing Address - Fax:
Practice Address - Street 1:7910 ATLANTIC AVE STE M
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-5774
Practice Address - Country:US
Practice Address - Phone:323-908-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTH CENTRAL FAMILY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-18
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)