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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