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NPI Code Detail

MEDICARE: WILMINGTON COMMUNITY CLINIC

MEDICARE: WILMINGTON COMMUNITY 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
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932194586
Entity Type Code : Organization
Provider Name (Legal Business Name) : WILMINGTON COMMUNITY CLINIC
Provider Business Mailing Address
First Line : 1009 N AVALON BLVD
Second Line :
City : WILMINGTON
State : CA
Zip : 90744-4505
Country : US
Telephone Number : 310-549-5760
Fax Number : 310-549-1453
Provider Business Practice Location Address
First Line : 1009 N AVALON BLVD
Second Line :
City : WILMINGTON
State : CA
Zip : 90744-4505
Country : US
Telephone Number : 310-549-5760
Fax Number : 310-549-2277
Authorized Official
Title or Position : REVENUE CYCLE MANAGER
Name : VERONICA RODARTE
Credential :
Telephone Number : 310-714-8521
Provider Enumeration Date : 09/20/2005
Last Update Date : 02/24/2026

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Directions to “WILMINGTON COMMUNITY CLINIC ” Practice Location

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