Healthcare Provider Details

I. General information

NPI: 1467363861
Provider Name (Legal Business Name): CENTRO MEDICO COMMUNITY CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7220 S. FIGUEROA ST.
LOS ANGELES CA
90003
US

IV. Provider business mailing address

1303 W 6TH ST STE 102
CORONA CA
92882-3196
US

V. Phone/Fax

Practice location:
  • Phone: 844-223-6876
  • Fax: 951-278-9895
Mailing address:
  • Phone: 844-223-6876
  • Fax: 951-278-9895

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: SAMAR MASRI
Title or Position: HR DIRECTOR
Credential:
Phone: 951-376-3097