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
831 E ARROW HWY, POMONA, CA 91767-2535
(818) 895-3100
(818) 892-4651
Mailing address
15206 PARTHENIA ST, NORTH HILLS, CA 91343-5305
(818) 895-3100
(818) 892-4651
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
960000465
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
551058
MEDICARE CERTIFICATION NUMBER
CA
Enumeration date
08/07/2009
Last updated
09/22/2011
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