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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
15206 PARTHENIA ST, NORTH HILLS, CA 91343-5305
(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
261QA0005X
Ambulatory Family Planning Facility
960000465
CA
261QC1500X
Community Health Clinic/Center
960000465
CA
261QD0000X
Dental Clinic/Center
FHC70436F
CA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
960000465
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
551023
MEDICARE PTAN
CA
01
EAP70436F
MEDICAL PROVIDER NUMBER
CA
01
FHC70436F
MEDICAL PROVIDER NUMBER
CA
01
HAP70436F
MEDICAL PROVIDER NUMBER
CA
Enumeration date
07/16/2006
Last updated
07/09/2010
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