MEDICARE: PRIME WELLNESS COMMUNITY HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1083251532
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME WELLNESS COMMUNITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	8610 S SEPULVEDA BLVD STE 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4009
Country	:	US
Telephone Number	:	310-659-7867
Fax Number	:	310-878-2118

Provider Business Practice Location Address
First Line	:	8610 S SEPULVEDA BLVD STE 104
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4009
Country	:	US
Telephone Number	:	310-659-7867
Fax Number	:	310-878-2118

Authorized Official
Title or Position	:	CEO
Name	:	DENYS SLESARENKO
Credential	:
Telephone Number	:	310-659-7867

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	06/22/2026

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Directions to “PRIME WELLNESS COMMUNITY HEALTH CENTER ” Practice Location

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