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General NPI Number Information
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NPI Number | 1497063192
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Entity Type | Organization
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Legal Business Name | MISSION CITY COMMUNITY NETWORK, INC.
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Dates
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Enumeration Date | 09/16/2010
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Last Update Date | 09/17/2013
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Provider Practice Location Address
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Address Line | 1818 N ORANGE GROVE AVE #205
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City | POMONA
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State | CA
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Zip | 91767-3028
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Country | US
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Telephone | 818-895-3100
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Fax | 818-892-4651
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Provider Business Mailing Address
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Address Line | 15206 PARTHENIA ST
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City | NORTH HILLS
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State | CA
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Zip | 91343-5305
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Country | US
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Telephone | 818-895-3100
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Fax | 818-892-4651
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Authorized Official
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Title or Position | C.E.O.
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Name | MR. NIK GUPTA
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Credential |
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Telephone | 818-895-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 960000465
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License Number State | CA
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