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 (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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