| NPI | 1972912236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESSICA BOSTICK Credentialing Specialist 323-724-0019 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2014-08-11 |
| Last Update Date | 2024-05-28 |