NPIMap

Organization Active NPI

University Muslim Medical Association Inc

Doing business as Jordan Wellness Center

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1114602406
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UNIVERSITY MUSLIM MEDICAL ASSOCIATION INC
Doing business as
Jordan Wellness Center
Practice address
10110 Juniper St
Los Angeles, CA 90002-3166
Phone
(323) 789-5610
Fax
(323) 789-5616
NPI assigned
Jun 15, 2023
Last updated
May 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Authorized official

Name
Alfredo Reynoso
Title
Chief Operating Officer
Phone
(323) 313-5588

Specialties & licenses 1

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

Addresses

Primary practice location

10110 Juniper St
Los Angeles, CA 90002-3166

Mailing address

711 W Florence Ave
Los Angeles, CA 90044-6105
Phone (323) 789-5610

Other names 1

  • Jordan Wellness 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
O20240711001981 CA Part B Supplier - Clinic/Group Practice 8628173564 Receives reassigned benefits from 1 practitioner
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Los Angeles, CA
O20251111002303 CA Part A Provider - Federally Qualified Health Center (FQHC) 8628173564 Practice locations: Los Angeles, CA

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1114602406. Details of each certification follow.

Federally qualified health center certification: CCN A11008

Legal name
UNIVERSITY MUSLIM MEDICAL ASSOCIATION INC
Doing business as
UMMA HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 3, 2025
Last certification
Oct 3, 2025
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
10110 Juniper St
Los Angeles, CA 90002-3166

Federally qualified health center certification: CCN 551970

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
JORDAN WELLNESS CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 14, 2004
Last certification
Jun 14, 2004
Ownership / control type
For profit – partnership
Facility address
10110 Juniper Street
Los Angeles, CA 90002

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
University Muslim Medical Association Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

2265 E 103rd St
Los Angeles, CA 90002
Phone (323) 564-4331

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Paul Wong Individual Corporate DirectorBoard Chair Jan 1, 2005
Munaf M Kadri Individual Corporate DirectorBoard Member Feb 1, 2009
Emily Reed Individual Corporate DirectorBoard Member May 22, 2019
Kathryn Hickman Windley Individual Corporate DirectorBoard Member Apr 25, 2018
Sandra Perkins Individual Corporate DirectorBoard Member Apr 24, 2024
Raziya Shaikh Individual Corporate DirectorTreasurer Jan 1, 1997
Shaakira Madany Individual Corporate DirectorBoard Member Mar 27, 2024
Alejandra Murillo Individual Corporate OfficerCfo Jul 20, 2020
Corporate DirectorCfo Jul 20, 2020
W-2 Managing EmployeeAd; Jul 20, 2020
Vivianna Trujillo Individual Corporate DirectorSecretary Jan 1, 2011
Rumi Cader Individual Corporate DirectorBoard Member Dec 18, 2020
Mehdireza Hirji Individual Corporate DirectorBoard Member Jan 1, 2017

Owners & managing parties with NPI records 2

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

NPI Registry JSON

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

{
    "created_epoch": "1686787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1114602406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 W FLORENCE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900446105",
            "telephone_number": "323-789-5610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10110 JUNIPER ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900023166",
            "telephone_number": "323-789-5610",
            "fax_number": "323-789-5616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY MUSLIM MEDICAL ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-15",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A",
        "authorized_official_last_name": "REYNOSO",
        "authorized_official_first_name": "ALFREDO",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "323-313-5588"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jordan Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jordan Wellness Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.