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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