Organization
EAST VALLEY COMMUNITY HEALTH CENTER, INC.
Active
Organization
EAST VALLEY COMMUNITY HEALTH CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ALICIA MARDINI (CHIEF EXECUTIVE OFFICER)
(626) 919-4333
Entity
Organization
Contact information
Practice address
17840 VILLA CORTA ST, LA PUENTE, CA 91744-5342
(626) 919-4333
(626) 919-2084
Mailing address
420 S GLENDORA AVE, WEST COVINA, CA 91790-3001
(626) 919-4333
(626) 919-2084
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
550002062
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
550002062
CA DEPARTMENT OF PUBLIC HEALTH LICENSE
CA
05
—
FHC12048F
—
CA
Enumeration date
12/06/2011
Last updated
02/11/2022
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