Organization
SOUTHERN CALIFORNIA MEDICAL CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELLIE ZARE (SR. PROGRAM MANGER)
(818) 650-6700
Entity
Organization
Contact information
Practice address
14550 HAYNES ST, VAN NUYS, CA 91411-1613
(818) 421-0809
Mailing address
PO BOX 436, VAN NUYS, CA 91408-0436
(818) 421-0809
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
03/15/2023
Last updated
06/13/2023
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