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
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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