Healthcare Provider Details

I. General information

NPI: 1215863378
Provider Name (Legal Business Name): PEDIATRIC AND FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4528 SLAUSON AVE
MAYWOOD CA
90270-2934
US

IV. Provider business mailing address

4528 SLAUSON AVE
MAYWOOD CA
90270-2934
US

V. Phone/Fax

Practice location:
  • Phone: 213-747-5542
  • Fax:
Mailing address:
  • Phone: 213-747-5542
  • 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: PIERRE CHAVEZ
Title or Position: SR FINANCIAL ANALYST
Credential:
Phone: 213-746-1037