Provider Demographics
NPI:1982075107
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 1:15477 VENTURA BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15477 VENTURA BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3006
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:2015-10-14
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty