Fundamental Health Center LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

License

G080589 Issued in CA

Legal business name

FUNDAMENTAL HEALTH CENTER LLC

Practice address

10323 Santa Monica Blvd
#109
Los Angeles, CA 90025-6071

Phone

(213) 364-2906

NPI assigned

Jan 15, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Darren Christopher Misaresh, MBA

Title

Ceo

Phone

(213) 364-2906

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1452816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1023475431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10323 SANTA MONICA BLVD",
            "address_2": "#109",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900256071",
            "telephone_number": "213-364-2906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10323 SANTA MONICA BLVD",
            "address_2": "#109",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900256071",
            "telephone_number": "213-364-2906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNDAMENTAL HEALTH CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-15",
        "last_updated": "2016-01-15",
        "status": "A",
        "authorized_official_last_name": "MISARESH",
        "authorized_official_first_name": "DARREN",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "213-364-2906",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "CA",
            "license": "G080589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Mental Health Clinic/Center in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Adult Mental Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.