MEDICARE: SOUTH BAY FAMILY HEALTHCARE 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)		CA

General Provider Information

NPI Number	:	1871933945
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BAY FAMILY HEALTHCARE CENTER

Provider Business Mailing Address
First Line	:	23430 HAWTHORNE BLVD
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90505-4720
Country	:	US
Telephone Number	:	310-802-6177
Fax Number	:	310-802-6178

Provider Business Practice Location Address
First Line	:	270 E 223RD ST
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90745-3804
Country	:	US
Telephone Number	:	310-802-6177
Fax Number	:	310-802-6178

Authorized Official
Title or Position	:	CEO
Name	:	JANN HAMILTON-LEE
Credential	:
Telephone Number	:	310-802-6177

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	07/14/2014

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Directions to “SOUTH BAY FAMILY HEALTHCARE CENTER ” Practice Location

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