Healthcare Provider Details

I. General information

NPI: 1114722295
Provider Name (Legal Business Name): CENTRAL CITY COMMUNITY HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5233 E BEVERLY BLVD STE A
LOS ANGELES CA
90022-2020
US

IV. Provider business mailing address

2019 SATURN ST
MONTEREY PARK CA
91755-7415
US

V. Phone/Fax

Practice location:
  • Phone: 323-694-2543
  • Fax:
Mailing address:
  • Phone: 323-724-0019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROSEMARY REYES
Title or Position: CEO
Credential: DO
Phone: 323-724-0019