Healthcare Provider Details

I. General information

NPI: 1639073141
Provider Name (Legal Business Name): PEDIATRIC AND FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 E IMPERIAL HWY STE 250
LYNWOOD CA
90262-5758
US

IV. Provider business mailing address

3680 E IMPERIAL HWY STE 250
LYNWOOD CA
90262-5758
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

VIII. Authorized Official

Name: PIERRE CHAVEZ
Title or Position: SR FINANCIAL ANALYST
Credential:
Phone: 213-746-1037