Organization
VENICE FAMILY CLINIC
Active
Parent organization
VENICE FAMILY CLINIC
Other names
Venice South Bay Gardena
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
742 W GARDENA BLVD, GARDENA, CA 90247-5024
(310) 802-6177
(310) 802-6178
Mailing address
604 ROSE AVE, VENICE, CA 90291-2767
(310) 392-8636
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
07/21/2021
Last updated
11/30/2023
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