Healthcare Provider Details

I. General information

NPI: 1215300603
Provider Name (Legal Business Name): MISSION CITY COMMUNITY NETWORK,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2015
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8771 VAN NUYS BLVD
PANORAMA CITY CA
91402-2401
US

IV. Provider business mailing address

8771 VAN NUYS BLVD
PANORAMA CITY CA
91402-2401
US

V. Phone/Fax

Practice location:
  • Phone: 818-895-3100
  • Fax: 818-893-9464
Mailing address:
  • Phone: 818-895-3100
  • Fax: 818-893-9464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NIK GUPTA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 818-895-3100