Mission City Community Network, Inc.
Organization Active NPI Community Health Clinic/Center · Pomona, CA
NPI 1497063192 · NPPES record last updated Sep 17, 2013
Key facts
- NPI
- 1497063192
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- License
- 960000465 (CA)
- Legal business name
- MISSION CITY COMMUNITY NETWORK, INC.
- Practice address
- 1818 N Orange Grove Ave
#205
Pomona, CA 91767-3028 - Phone
- (818) 895-3100
- Fax
- (818) 892-4651
- NPI assigned
- Sep 16, 2010
- Organization subpart
- No
Authorized official
- Name
- Mr. Nik Gupta
- Title
- C.E.O.
- Phone
- (818) 895-3100
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 17
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Federally qualified health center certification: CCN 551058
- Legal name
- MISSION CITY COMMUNITY NETWORK, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Oct 4, 2010
- Last certification
- Oct 4, 2010
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 6, 1989 in CA
- Enrollment address
- 1818 N Orange Grove Ave
Ste 205
Pomona, CA 91767-3028
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Nik Gupta |
Corporate Officer |
Mar 16, 2001 | |
| Corporate Director |
Jul 1, 2009 | ||
| W-2 Managing Employee |
Jul 1, 2009 | ||
| Frank Gonzales |
Corporate Officer |
Jun 13, 2017 | |
| Aida Vlught |
Corporate Officer |
Jul 1, 2000 | |
| Norma J Solis |
Corporate Officer |
Jun 30, 2021 | |
| Maria Chaudhry |
Corporate Officer |
Dec 1, 2012 | |
| Sammy Riley |
Corporate Officer |
Feb 23, 2021 | |
| Mark Berry |
Corporate Officer |
Aug 19, 2017 | |
| Adriana Guzman |
Corporate Officer |
Mar 17, 2014 | |
| Magdalena Almira |
Corporate Officer |
Feb 20, 2007 | |
| Rosalind Scarbrough |
Corporate Officer |
Feb 23, 2021 | |
| Derek Biesheuvel |
Corporate Officer |
Mar 17, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101004000914 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 1658264684 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: North Hills, CA; Pomona, CA |
National Provider Directory
- Tax ID family
- Mission City Community NTWK
Locations
1818 N Orange Grove Ave
Ste 205
Pomona, CA 91767
Phone (909) 623-1266
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | 960000465 | CA | Yes |
Addresses
Primary practice location
1818 N Orange Grove Ave
#205
Pomona, CA 91767-3028
Mailing address
15206 Parthenia St
North Hills, CA 91343-5305
Phone (818) 895-3100
Other providers in Pomona, CA
- Parisa Mirjalili
- Miro Itskovich, DDS Inc.
- Areeba Misbah
- Francis Gabriel Mision
- Alyssa Missakian
- Mission City Community Network, Inc.
- Mission City Community Network, Inc.
- Madelyn Rose Uyemura Mix
- Shannon Melody Mizrahi
- MJB Partners LLC
All providers in Pomona, CA · Community Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.