Organization
MISSION CITY COMMUNITY NETWORK, INC.
Active
Organization
MISSION CITY COMMUNITY NETWORK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NIK GUPTA (CHEIF EXECUTIVE OFFICER)
(818) 895-3100
Entity
Organization
Contact information
Practice address
8363 RESEDA BLVD STE 11, NORTHRIDGE, CA 91324-4694
(818) 998-7085
(818) 998-3579
Mailing address
8527 SEPULVEDA BLVD, NORTH HILLS, CA 91343-5824
(818) 895-3100
(818) 892-3352
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
550000351
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EAP70436F
MEDICAL PROVIDER NUMBER
CA
01
—
FHC70436F
MEDICAL PROVIDER NUMBER
CA
01
—
HAP70436F
MEDICAL PROVIDER NUMBER
CA
Enumeration date
10/31/2008
Last updated
06/06/2019
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