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NPI Code Detail

MEDICARE: VENICE FAMILY CLINIC

MEDICARE: VENICE FAMILY CLINIC
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
1171M00000XCase Manager/Care Coordinator
2261QC1500XCommunity Health Clinic/Center960000960CA
3261QF0400XFederally Qualified Health Center (FQHC)

General Provider Information

NPI Number : 1558397067
Entity Type Code : Organization
Provider Name (Legal Business Name) : VENICE FAMILY CLINIC
Provider Business Mailing Address
First Line : 604 ROSE AVE
Second Line :
City : VENICE
State : CA
Zip : 90291-2767
Country : US
Telephone Number : 310-392-8636
Fax Number :
Provider Business Practice Location Address
First Line : 2509 PICO BLVD
Second Line :
City : SANTA MONICA
State : CA
Zip : 90405-1828
Country : US
Telephone Number : 310-392-8636
Fax Number :
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : DR. MITESH G POPAT
Credential : MD
Telephone Number : 310-664-7901
Provider Enumeration Date : 06/25/2006
Last Update Date : 09/11/2023

Similar Medicare Providers

1720053978 — SOPHIE H CHANG MD
Practice Location Address:
2509 PICO BLVD
SANTA MONICA, CA
90405-1828
Practice Phone: 310-392-8636
Practice Fax:
1245274125 — JOHN A ROOHAN MD
Practice Location Address:
2509 PICO BLVD
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90405-1828
Practice Phone: 310-392-8636
Practice Fax: 310-392-6642
1760409692 — DR. INDULAL M. NAGRECHA D.D.S.
Practice Location Address:
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SANTA MONICA, CA
90405-1828
Practice Phone: 310-664-7885
Practice Fax: 310-664-7590
1477665248 — CAROL ROSE SCHWARTZ M.D.
Practice Location Address:
2509 PICO BLVD
SANTA MONICA, CA
90405-1828
Practice Phone: 310-392-8636
Practice Fax: 310-829-4632
1235323080 — COUNTY OF LOS ANGELES
Practice Location Address:
2509 PICO BLVD
SANTA MONICA, CA
90405-1828
Practice Phone: 310-998-3203
Practice Fax:
1588859375 — DR. JASPREET KAUR
Practice Location Address:
2509 PICO BLVD
SANTA MONICA, CA
90405-1828
Practice Phone: 310-664-7878
Practice Fax:

Directions to “VENICE FAMILY CLINIC ” Practice Location

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