| Organization Name: | MISSION CITY COMMUNITY NETWORK, INC. |
| NPI Number: | 1063795250 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NIK GUPTA (CHIEF EXECUTIVE OFFICER) |
| Mailing Address: | 513 E Lime Ave Suite 103 Monrovia |
| State: | CA US |
| Postal Code: | 910162982 |
| Phone Number: | 8188953100 |
| Fax Number: | 8188939464 |
| NPI Enumeration Date: | 09/23/2011 |
| NPI Last Update Date: | 09/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 960000465 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |