Provider Demographics
NPI:1669799896
Name:SOUTH CENTRAL FAMILY HEALTH CENTER
Entity type:Organization
Organization Name:SOUTH CENTRAL FAMILY HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:VELOZ
Authorized Official - Suffix:
Authorized Official - Credentials:JD,MPH
Authorized Official - Phone:323-908-4247
Mailing Address - Street 1:4425 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90011-3629
Mailing Address - Country:US
Mailing Address - Phone:323-908-4200
Mailing Address - Fax:323-908-4256
Practice Address - Street 1:2680 SATURN AVE STE 220&280
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4377
Practice Address - Country:US
Practice Address - Phone:323-908-4200
Practice Address - Fax:323-908-4256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669799896Medicaid
CA551073Medicare PIN