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NPI Code Detail

MEDICARE: WESTSIDE FAMILY HEALTH CENTER

MEDICARE: WESTSIDE FAMILY 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
1261Q00000XClinic/Center
2261Q00000XClinic/CenterEAP11798FCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1EAP11798FOTHERCAEAPC

General Provider Information

NPI Number : 1407033616
Entity Type Code : Organization
Provider Name (Legal Business Name) : WESTSIDE FAMILY HEALTH CENTER
Provider Business Mailing Address
First Line : 3861 SEPULVEDA BLVD
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4605
Country : US
Telephone Number : 309-450-4773
Fax Number : 310-450-0873
Provider Business Practice Location Address
First Line : 3861 SEPULVEDA BLVD
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4605
Country : US
Telephone Number : 309-450-4773
Fax Number : 310-450-0873
Authorized Official
Title or Position : PRESIDENT/CEO
Name : DEBRA ANN FARMER
Credential :
Telephone Number : 309-450-4773
Provider Enumeration Date : 01/30/2008
Last Update Date : 08/25/2020

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Directions to “WESTSIDE FAMILY HEALTH CENTER ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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