Organization
MISSION CITY COMMUNITY NETWORK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NIK GUPTA (CHIEF EXECUTIVE OFFICER)
(818) 895-3100
Entity
Organization
Contact information
Practice address
9919 LAUREL CANYON BLVD, PACOIMA, CA 91331-3940
(818) 686-4243
(818) 686-4259
Mailing address
15206 PARTHENIA ST, NORTH HILLS, CA 91343-5305
(818) 895-3100
(818) 892-3352
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
960001450
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
960001450
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
03/14/2008
Last updated
07/10/2010
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