MEDICARE: UNICARE 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	:	1720571789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNICARE COMMUNITY HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	437 N EUCLID AVE
Second Line	:
City	:	ONTARIO
State	:	CA
Zip	:	91762-3456
Country	:	US
Telephone Number	:	909-988-2555
Fax Number	:	909-391-3081

Provider Business Practice Location Address
First Line	:	741 S ALVARADO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4021
Country	:	US
Telephone Number	:	213-413-6666
Fax Number	:	213-353-4566

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	AVETIK MACHKALYAN
Credential	:
Telephone Number	:	909-988-2555

Provider Enumeration Date	:	06/13/2018
Last Update Date	:	03/13/2024

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