| NPI | 1972040467 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARICELA MENDOZA Managed Care Lead 323-724-0019 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2017-01-23 |
| Last Update Date | 2020-02-11 |