NPIMap

Organization Active NPI

Central City Community Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Stanton, CA
National Provider Identifier
1174757967
Registry record updated Dec 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
960000901 Issued in CA
Legal business name
CENTRAL CITY COMMUNITY HEALTH CENTER INC
Practice address
12116 Beach Blvd
Stanton, CA 90680
Phone
(714) 898-2222
Fax
(714) 894-9865
NPI assigned
May 7, 2009
Last updated
Dec 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2025

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

Authorized official

Name
Rosemary David Reyes, DONPI 1619105327
Title
Ceo
Phone
(714) 490-2750

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 960000901 CA Primary

Addresses

Primary practice location

12116 Beach Blvd
Stanton, CA 90680

Mailing address

2019 Saturn St
Monterey Park, CA 91755-7415
Phone (323) 724-0019

Other identifiers 1

IdentifierTypeStateIssuer
FHC70614FMedicaidCA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041025001177 CA Part B Supplier - Clinic/Group Practice 6608837331 Receives reassigned benefits from 105 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: El Monte, CA; Upland, CA; Stanton, CA; Norco, CA; Los Angeles, CA; La Puente, CA; Indio, CA; Garden Grove, CA…
O20101118000737 CA Part A Provider - Federally Qualified Health Center (FQHC) 6608837331 Practice locations: Stanton, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174757967. Details of each certification follow.

Federally qualified health center certification: CCN 551097

Legal name
CENTRAL CITY COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 22, 2010
Last certification
Nov 22, 2010
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 26, 1994 in CA
Enrollment address
12116 Beach Blvd
Stanton, CA 90680-3704

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 13

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

View all 13

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D0695145Central City Community12116 Beach Blvd, Stanton, CA 90680Provider-performed microscopyJul 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Central City Community Health Center14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

2237 W Ball Rd
Anaheim, CA 92804
Phone (714) 490-2750

12116 Beach Blvd
Stanton, CA 90680
Phone (714) 498-2222

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Juan Duran Individual Corporate Director Jan 1, 2010
Violeta Wang Individual Corporate Director Jan 1, 2023
Rosemary David Reyes Individual Corporate OfficerCeo Jun 1, 2021 100%
W-2 Managing EmployeeCeo Jun 1, 2021 100%
Patricia Torres Individual W-2 Managing EmployeeExecutive Assistant Jun 1, 2021
Larry Landless Individual Corporate Director Jan 1, 2023

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1241654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765843200000",
    "number": "1174757967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 SATURN ST",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917557415",
            "telephone_number": "323-724-0019",
            "fax_number": "323-248-7044"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12116 BEACH BLVD",
            "city": "STANTON",
            "state": "CA",
            "postal_code": "90680",
            "telephone_number": "714-898-2222",
            "fax_number": "714-894-9865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL CITY COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-07",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "ROSEMARY",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "714-490-2750",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "960000901",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70614F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stanton, CA

Sources for this page

Verify at the official NPI Registry.