NPIMap

Organization Active NPI

Apla Health & Wellness

Doing business as APLA Health - Michael Gottlieb Health Center

  • Federally Qualified Health Center (FQHC)
  • West Hollywood, CA
National Provider Identifier
1104688795
Registry record updated Oct 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
APLA HEALTH & WELLNESS
Doing business as
APLA Health - Michael Gottlieb Health Center
Practice address
7531 Santa Monica Blvd Ste 100
West Hollywood, CA 90046-6458
Phone
(323) 988-1400
NPI assigned
Jan 29, 2024
Last updated
Oct 31, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2024

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

Authorized official

Name
Joseph Moldovan
Title
Chief Financial Officer
Phone
(213) 201-1411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

7531 Santa Monica Blvd Ste 100
West Hollywood, CA 90046-6458

Mailing address

611 S Kingsley Dr
Los Angeles, CA 90005-2319

Other names 1

  • APLA Health - Michael Gottlieb Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160420000343 CA Part B Supplier - Clinic/Group Practice 4385875236 Receives reassigned benefits from 3 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA; Long Beach, CA; West Hollywood, CA
O20241216000850 CA Part A Provider - Federally Qualified Health Center (FQHC) 4385875236 Practice locations: West Hollywood, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104688795. Details of each certification follow.

Federally qualified health center certification: CCN A01902

Legal name
APLA HEALTH & WELLNESS
Doing business as
APLA HEALTH - MICHAEL GOTTLIEB HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 16, 2024
Last certification
Dec 16, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 16, 2004 in CA
Enrollment address
7531 Santa Monica Blvd
Ste 100
West Hollywood, CA 90046-6458

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Apla Health Wellness12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1679 E 120th St
Ste 101102
Los Angeles, CA 90059
Phone (323) 329-9700

7531 Santa Monica Blvd
Ste 201
West Hollywood, CA 90046
Phone (213) 201-1437

Ownership & related parties

All disclosed owners & managing parties 25

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lee Klosinski Individual Corporate OfficerBoard Chair Oct 22, 2013
Corporate DirectorBoard Member Oct 22, 2013
Devin Martinez Individual Corporate Director Aug 28, 2024
Jessie McGrath Individual Corporate OfficerBoard Vice Chair Jan 1, 2017
Corporate DirectorBoard Member Jan 1, 2017
Cody Sisco Individual Corporate DirectorBoard Member Jun 26, 2019
Daphne Kay Redding Individual Corporate OfficerSecretary Jun 26, 2024
Corporate Director Jun 28, 2023
Joseph Moldovan Individual Corporate OfficerChief Financial Officer Aug 1, 2024
W-2 Managing EmployeeChief Financial Officer Jan 9, 2023
Christopher Tang Individual Corporate DirectorBoard Member Jun 30, 2021
John Squatritto Individual Corporate DirectorBoard Member Jun 26, 2019
Craig E Thompson Individual Corporate OfficerChief Executive Officer Jan 6, 1997
W-2 Managing EmployeeChief Executive Officer Jan 6, 1997
Raul Rios Individual Corporate Director Aug 28, 2024
Jay E Gladstein Individual W-2 Managing EmployeeChief Medical Officer Dec 1, 2017
Stuart Downey Individual Corporate Director Jun 28, 2023
Andrew Clark Individual Corporate Director Jun 28, 2023
Chad Franks Individual Corporate DirectorBoard Member Jun 26, 2019
Elwood Sides Individual Corporate Director Jun 28, 2023
Christine Cowan Individual Corporate Director Aug 28, 2024
David Flores Individual Corporate Director Jun 28, 2023
James Patton Individual Corporate DirectorBoard Member Dec 2, 2023
Maricela de Rivera Individual Corporate DirectorBoard Member Jun 30, 2021
Lindsey Morrison Individual Corporate DirectorBoard Member Jun 30, 2021
John Sealy Individual Corporate DirectorBoard Member Jun 26, 2019
Natalia Ramos Individual Corporate DirectorBoard Member Jun 26, 2019
David Doan Individual Corporate Director Jun 28, 2023
M'Alyssa Mecenas Individual Corporate DirectorBoard Member Jun 24, 2020
Denis Cagna Individual Corporate OfficerTreasurer Jun 26, 2024
Corporate Director Jun 28, 2023

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Apla Health & Wellness - David Geffen CenterLos Angeles, CA, CCN 751061 Federally qualified health center Other (100%) Oct 9, 2012
Apla Health - Olympic #310Los Angeles, CA, CCN 921032 Federally qualified health center Other Oct 22, 2013

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1706486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730332800000",
    "number": "1104688795",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 S KINGSLEY DR",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900052319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7531 SANTA MONICA BLVD STE 100",
            "city": "WEST HOLLYWOOD",
            "state": "CA",
            "postal_code": "900466458",
            "telephone_number": "323-988-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APLA HEALTH & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-29",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A",
        "authorized_official_last_name": "MOLDOVAN",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "213-201-1411"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "APLA Health - Michael Gottlieb Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "APLA Health - Michael Gottlieb Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Hollywood, CA

Sources for this page

Verify at the official NPI Registry.