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NPI Code Detail

MEDICARE: MISSION CITY COMMUNITY NETWORK, INC.

MEDICARE: MISSION CITY COMMUNITY NETWORK, 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
1261QF0400XFederally Qualified Health Center (FQHC)960001162CA

General Provider Information

NPI Number : 1992246979
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSION CITY COMMUNITY NETWORK, INC.
Provider Business Mailing Address
First Line : 8527 SEPULVEDA BLVD
Second Line :
City : NORTH HILLS
State : CA
Zip : 91343-5824
Country : US
Telephone Number : 818-895-3100
Fax Number : 818-893-9464
Provider Business Practice Location Address
First Line : 2655 W. OLYMPIC BLVD.,
Second Line :
City : LOS ANGELES
State : CA
Zip : 90006-2810
Country : US
Telephone Number : 818-895-3100
Fax Number : 818-893-9464
Authorized Official
Title or Position : CEO
Name : NIK GUPTA
Credential :
Telephone Number : 818-895-3100
Provider Enumeration Date : 03/10/2017
Last Update Date : 03/14/2017

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Directions to “MISSION CITY COMMUNITY NETWORK, INC. ” Practice Location

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