Healthcare Provider Details

I. General information

NPI: 1790051423
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: 03/27/2012
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12113 WOODRUFF AVE SUITE A
DOWNEY CA
90241
US

IV. Provider business mailing address

6001 E WASHINGTON BLVD
COMMERCE CA
90040-2451
US

V. Phone/Fax

Practice location:
  • Phone: 562-231-5600
  • Fax: 562-803-1430
Mailing address:
  • Phone: 562-928-9600
  • Fax: 562-927-6974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. RAQUEL VILLA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 562-928-9600