Organization
MISSION CITY COMMUNITY NETWORK, INC.
Active
Other names
MISSION CITY COMMUNITY NETWORK, INC.-GLENDALE
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NIK GUPTA (PRESIDENT/CEO)
(818) 895-3100
Entity
Organization
Contact information
Practice address
222 W EULALIA ST STE 301, GLENDALE, CA 91204-2851
(818) 895-3100
(818) 893-9464
Mailing address
8527 SEPULVEDA BLVD, NORTH HILLS, CA 91343-5824
(818) 895-3100
(818) 893-9464
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
550001476
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
550001476
STATE LICENSE
CA
Enumeration date
12/05/2017
Last updated
06/16/2018
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