=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003770447
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESLEY HEALTH CENTERS - MIDNIGHT MISSION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2025
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 601 S SAN PEDRO ST STE 1A
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90014-2415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-733-5924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5650 JILLSON ST
-----------------------------------------------------
City | COMMERCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90040-1482
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 866-733-5924
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. ALVARO PROSPERO BALLESTEROS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 323-201-4516
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------