MEDICARE: COMPLETE CARE COMMUNITY HEALTH CENTER, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1578205019
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE CARE COMMUNITY HEALTH CENTER, INC

Provider Business Mailing Address
First Line	:	3000 S ROBERTSON BLVD STE 280
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-3144
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4849 VAN NUYS BLVD STE 102
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-2117
Country	:	US
Telephone Number	:	310-730-6362
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	YURY AKOPYAN
Credential	:
Telephone Number	:	310-730-6362

Provider Enumeration Date	:	04/13/2022
Last Update Date	:	04/13/2022

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