| NPI | 1861677650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OMAR J KENYATTA Billing Manager 323-357-6684 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) (Licence: CA 960000216) |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2007-12-31 |