NPIMap

Organization Active NPI

Mission City Community Network, Inc.

  • Community Health Clinic/Center
  • Pomona, CA
National Provider Identifier
1497063192
Registry record updated Sep 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
License
960000465 Issued in 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
Last updated
Sep 17, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2013

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

Authorized official

Name
Mr. Nik Gupta
Title
C.E.O.
Phone
(818) 895-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X 960000465 CA Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497063192. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Sep 6, 1989 in CA
Enrollment address
1818 N Orange Grove Ave
Ste 205
Pomona, CA 91767-3028

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Mission City Community NTWK18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

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

View all 17

Locations

1818 N Orange Grove Ave
Ste 205
Pomona, CA 91767
Phone (909) 623-1266

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
Nik Gupta Individual Corporate OfficerBoard Member Mar 16, 2001
Corporate DirectorCeo Jul 1, 2009
W-2 Managing EmployeeCeo Jul 1, 2009
Frank Gonzales Individual Corporate OfficerBoard Member Jun 13, 2017
Aida Vlught Individual Corporate OfficerBoard Member Jul 1, 2000
Norma J Solis Individual Corporate OfficerBoard Member Jun 30, 2021
Maria Chaudhry Individual Corporate OfficerBoard Member Dec 1, 2012
Sammy Riley Individual Corporate OfficerBoard Member Feb 23, 2021
Mark Berry Individual Corporate OfficerBoard Member Aug 19, 2017
Adriana Guzman Individual Corporate OfficerBoard Member Mar 17, 2014
Magdalena Almira Individual Corporate OfficerCfo Feb 20, 2007
Rosalind Scarbrough Individual Corporate OfficerBoard Member Feb 23, 2021
Derek Biesheuvel Individual Corporate OfficerBoard Member Mar 17, 2014

NPI Registry JSON

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1379376000000",
    "number": "1497063192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15206 PARTHENIA ST",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913435305",
            "telephone_number": "818-895-3100",
            "fax_number": "818-892-4651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 N ORANGE GROVE AVE",
            "address_2": "#205",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917673028",
            "telephone_number": "818-895-3100",
            "fax_number": "818-892-4651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION CITY COMMUNITY NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-16",
        "last_updated": "2013-09-17",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "NIK",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "818-895-3100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "960000465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

Verify at the official NPI Registry.