Healthcare Provider Details

I. General information

NPI: 1407268709
Provider Name (Legal Business Name): PEDIATRIC AND FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 E IMPERIAL HWY SUITE 200
LYNWOOD CA
90262-2659
US

IV. Provider business mailing address

3680 E IMPERIAL HWY SUITE 200
LYNWOOD CA
90262-2659
US

V. Phone/Fax

Practice location:
  • Phone: 310-608-4898
  • Fax:
Mailing address:
  • Phone: 310-608-4898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name: MONICA MCCARTHY
Title or Position: SR VP, COO & INTERIM-CEO
Credential:
Phone: 213-747-5542