| Organization Name: | VENICE FAMILY CLINIC |
| NPI Number: | 1003842360 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ELIZABETH BENSON FORER (CEO) |
| Mailing Address: | 4700 Inglewood Blvd #102 Culver City |
| State: | CA US |
| Postal Code: | 902305896 |
| Phone Number: | 3103928636 |
| Fax Number: | 3106647913 |
| NPI Enumeration Date: | 06/25/2006 |
| NPI Last Update Date: | 07/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | 960001387 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |