Healthcare Provider Details

I. General information

NPI: 1750711586
Provider Name (Legal Business Name): FAMILY HEALTH CARE CENTERS OF GREATER LOS ANGELES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 11/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6513 S. GAFIELD AVENUE
BELL GARDENS CA
90201-1815
US

IV. Provider business mailing address

6501 S. GAFIELD AVENUE
BELL GARDENS CA
90201
US

V. Phone/Fax

Practice location:
  • Phone: 562-928-9600
  • Fax: 562-927-8603
Mailing address:
  • Phone: 562-928-9600
  • Fax: 562-927-8603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number23236
License Number StateCA

VIII. Authorized Official

Name: MR. SERGIO N RIVAS
Title or Position: NP
Credential: NP
Phone: 562-587-3635