Organization
VENICE FAMILY CLINIC
Active
Parent organization
VENICE FAMILY CLINIC
Other names
Irma Colen Health Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
VENICE FAMILY CLINIC
Authorized official
DR. MITESH G POPAT MD (CHIEF EXECUTIVE OFFICER)
(310) 664-7901
Entity
Organization
Contact information
Practice address
4700 INGLEWOOD BLVD, #102, CULVER CITY, CA 90230-5896
(310) 392-8636
(310) 664-7913
Mailing address
604 ROSE AVE, VENICE, CA 90291-2767
(310) 392-8636
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
261QC1500X
Community Health Clinic/Center
960001387
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
06/25/2006
Last updated
09/07/2023
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