Healthcare Provider Details

I. General information

NPI: 1174757967
Provider Name (Legal Business Name): CENTRAL CITY COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2009
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12116 BEACH BLVD
STANTON CA
90680
US

IV. Provider business mailing address

2019 SATURN ST
MONTEREY PARK CA
91755-7415
US

V. Phone/Fax

Practice location:
  • Phone: 714-898-2222
  • Fax: 714-894-9865
Mailing address:
  • Phone: 323-724-0019
  • Fax: 323-248-7044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number960000901
License Number StateCA

VIII. Authorized Official

Name: ROSEMARY DAVID REYES
Title or Position: CEO
Credential: DO
Phone: 714-490-2750