Organization Name: | MISSION CITY COMMUNITY NETWORK, INC. |
NPI Number: | 1083062343 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NIK GUPTA (CEO) |
Mailing Address: | 9919 Laurel Canyon Blvd Pacoima |
State: | CA US |
Postal Code: | 913313940 |
Phone Number: | 8188953100 |
Fax Number: | |
NPI Enumeration Date: | 05/27/2016 |
NPI Last Update Date: | 05/27/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |