Healthcare Provider Details

I. General information

NPI: 1982075107
Provider Name (Legal Business Name): PEDIATRIC AND FAMILY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2015
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15477 VENTURA BLVD SUITE 300
SHERMAN OAKS CA
91403-3006
US

IV. Provider business mailing address

15477 VENTURA BLVD SUITE 300
SHERMAN OAKS CA
91403-3006
US

V. Phone/Fax

Practice location:
  • Phone: 213-747-5542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateCA
# 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