NPIMap

Organization Active NPI

Santo Nino Health Center

  • Federally Qualified Health Center (FQHC)
  • Panorama City, CA
National Provider Identifier
1194461129
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SANTO NINO HEALTH CENTER
Practice address
14427 Chase St Ste 100
Panorama City, CA 91402-3020
Phone
(818) 830-7751
Fax
(818) 891-7892
NPI assigned
May 11, 2022
Last updated
Jan 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Authorized official

Name
Dr. Glenn Marshak, MDNPI 1104890029
Title
Ceo
Phone
(818) 830-7751

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

14427 Chase St Ste 100
Panorama City, CA 91402-3020

Mailing address

14427 Chase St Ste 100
Panorama City, CA 91402-3020
Phone (818) 830-7751

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230906002545 CA Part B Supplier - Clinic/Group Practice 6305200593 Receives reassigned benefits from 21 practitioners
Practice locations: Burbank, CA; Mission Hills, CA; Panorama City, CA
O20250418000278 CA Part A Provider - Federally Qualified Health Center (FQHC) 6305200593 Practice locations: Panorama City, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194461129. Details of each certification follow.

Federally qualified health center certification: CCN A01944

Legal name
SANTO NINO HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 15, 2025
Last certification
Apr 15, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
14427 Chase St
Ste 100
Panorama City, CA 91402-3020

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
05D0983914Santo Nino Health Center14427 Chase St, Ste 100, Panorama City, CA 91402Certificate of waiverMar 7, 2027

National Provider Directory

National Provider Directory

Locations

191 S Buena Vista St
Ste 240
Burbank, CA 91505
Phone (818) 557-7278

14427 Chase St
Ste 208
Panorama City, CA 91402
Phone (818) 830-7751

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
Abraham Aguilar Individual Corporate OfficerBoard Member Dec 1, 2024
Nathaniel Buddy Hart Individual Corporate OfficerChairman of the Board Dec 1, 2024
Leonarda Guadalupe Aguilar Individual Corporate OfficerBoard Member Dec 1, 2024
Anna Shirley Friedman Individual Corporate OfficerBoard Secretary Dec 1, 2024
Mariette Chorbadjian Individual Operational/Managerial ControlVP of Clinic Operation Dec 4, 2024
Mutya Alvarez Individual Corporate OfficerBoard Member Dec 1, 2024
Marissa de la Fuente Individual Corporate OfficerBoard Member Dec 1, 2024
Michael Torgan Individual Corporate OfficerCfo Dec 1, 2024
Miguel Alarcon Individual Corporate OfficerBoard Member Dec 1, 2024
Glenn a Marshak Individual Corporate OfficerCeo Dec 1, 2024
Sunghee M Myung-Koziol Individual Corporate OfficerBoard Treasurer Dec 1, 2024

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 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1652227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736985600000",
    "number": "1194461129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14427 CHASE ST STE 100",
            "city": "PANORAMA CITY",
            "state": "CA",
            "postal_code": "914023020",
            "telephone_number": "818-830-7751",
            "fax_number": "818-891-7892"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14427 CHASE ST STE 100",
            "city": "PANORAMA CITY",
            "state": "CA",
            "postal_code": "914023020",
            "telephone_number": "818-830-7751",
            "fax_number": "818-891-7892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTO NINO HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-11",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A",
        "authorized_official_last_name": "MARSHAK",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-830-7751",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Panorama City, CA

Sources for this page

Verify at the official NPI Registry.