MEDICARE: PEDIATRIC AND FAMILY MEDICAL 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	:	1417883570
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC AND FAMILY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	2765 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5750
Country	:	US
Telephone Number	:	213-747-5542
Fax Number	:

Provider Business Practice Location Address
First Line	:	2765 E FLORENCE AVE
Second Line	:
City	:	HUNTINGTON PARK
State	:	CA
Zip	:	90255-5750
Country	:	US
Telephone Number	:	213-747-5542
Fax Number	:

Authorized Official
Title or Position	:	SR FINANCIAL ANALYST
Name	:	PIERRE CHAVEZ
Credential	:
Telephone Number	:	213-746-1037

Provider Enumeration Date	:	06/18/2026
Last Update Date	:	06/18/2026

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