Organization
VIA CARE COMMUNITY HEALTH CENTER-ELAC STUDENT HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VANESSA FUENTES (BILLING MANAGER)
(323) 268-9191
Entity
Organization
Contact information
Practice address
1301 AVENIDA CESAR CHAVEZ, F5-302, MONTEREY PARK, CA 91754-6099
(323) 268-9191
Mailing address
501 S ATLANTIC BLVD, LOS ANGELES, CA 90022-2621
(323) 268-9191
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FQHC
FQHC
—
Enumeration date
10/04/2019
Last updated
10/23/2020
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