Healthcare Provider Details

I. General information

NPI: 1730428293
Provider Name (Legal Business Name): MISSION CITY COMMUNITY NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 04/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8527 SEPULVEDA BLVD STE 131
NORTH HILLS CA
91343-5824
US

IV. Provider business mailing address

8527 SEPULVEDA BLVD STE 131
NORTH HILLS CA
91343-5824
US

V. Phone/Fax

Practice location:
  • Phone: 818-895-3100
  • Fax: 818-892-4651
Mailing address:
  • Phone: 818-895-3100
  • Fax: 818-892-4651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NIK GUPTA
Title or Position: CEO
Credential:
Phone: 818-895-3100