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General NPI Number Information
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NPI Number | 1114722295
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Entity Type | Organization
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Legal Business Name | CENTRAL CITY COMMUNITY HEALTH CENTER, INC.
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Dates
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Enumeration Date | 02/13/2025
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Last Update Date | 02/13/2025
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Provider Practice Location Address
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Address Line | 5233 E BEVERLY BLVD STE A
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City | LOS ANGELES
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State | CA
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Zip | 90022-2020
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Country | US
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Telephone | 323-694-2543
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Fax |
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Provider Business Mailing Address
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Address Line | 2019 SATURN ST
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City | MONTEREY PARK
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State | CA
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Zip | 91755-7415
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Country | US
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Telephone | 323-724-0019
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROSEMARY REYES
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Credential | DO
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Telephone | 323-724-0019
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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