MEDICARE: SOUTH CENTRAL FAMILY HEALTH CENTER

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	:	1649792615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH CENTRAL FAMILY HEALTH CENTER

Provider Business Mailing Address
First Line	:	4425 S CENTRAL AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-3629
Country	:	US
Telephone Number	:	323-908-4200
Fax Number	:	323-908-4256

Provider Business Practice Location Address
First Line	:	1028 E VERNON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90011-3717
Country	:	US
Telephone Number	:	323-908-4200
Fax Number	:	323-908-4256

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. RICHARD VELOZ
Credential	:	JD
Telephone Number	:	323-908-4247

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	07/12/2017

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