MEDICARE: CENTRAL CITY COMMUNITY HEALTH CENTER, INC.

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	:	1114722295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL CITY COMMUNITY HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	2019 SATURN ST
Second Line	:
City	:	MONTEREY PARK
State	:	CA
Zip	:	91755-7415
Country	:	US
Telephone Number	:	323-724-0019
Fax Number	:

Provider Business Practice Location Address
First Line	:	5233 E BEVERLY BLVD STE A
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2020
Country	:	US
Telephone Number	:	323-694-2543
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROSEMARY REYES
Credential	:	DO
Telephone Number	:	323-724-0019

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	02/13/2025

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