| NPI | 1629936661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAHINA CLARIZZA HERNANDEZ Credentialing & Compliance Analyst 310-547-0202 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 207Q00000X Family Medicine | |
| Enumeration Date | 2026-01-09 |
| Last Update Date | 2026-01-12 |