Healthcare Provider Details

I. General information

NPI: 1871837344
Provider Name (Legal Business Name): VENICE FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 ROSE AVE
VENICE CA
90291-2767
US

IV. Provider business mailing address

604 ROSE AVE
VENICE CA
90291-2767
US

V. Phone/Fax

Practice location:
  • Phone: 310-664-7735
  • Fax: 310-396-9360
Mailing address:
  • Phone: 310-392-8636
  • Fax: 310-664-7711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number51023
License Number StateCA

VIII. Authorized Official

Name: ISABELA MIHAI
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 310-593-9594