Mission City Community Network, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

MISSION CITY COMMUNITY NETWORK, INC.

Practice address

9808 Venice Blvd
Culver City, CA 90232-2732

Phone

(818) 895-3100

NPI assigned

May 24, 2016

Last updated

Jan 5, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nik Gupta

Title

Ceo

Phone

(818) 895-3100

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1528416104. Details of each certification follow.

• CCN 921058 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 921058

Legal name

MISSION CITY COMMUNITY NETWORK INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 20, 2018

Last certification

Feb 20, 2018

Ownership / control type

For profit – corporation

Facility address

9808 Venice Blvd, Suite 404
Culver City, CA 90232

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

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1515110400000",
    "number": "1528416104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8527 SEPULVEDA BLVD",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913435824",
            "telephone_number": "818-895-3100",
            "fax_number": "818-893-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9808 VENICE BLVD",
            "city": "CULVER CITY",
            "state": "CA",
            "postal_code": "902322732",
            "telephone_number": "818-895-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION CITY COMMUNITY NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-24",
        "last_updated": "2018-01-05",
        "status": "A",
        "authorized_official_last_name": "GUPTA",
        "authorized_official_first_name": "NIK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-895-3100"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alyssa Lauren Miramontes
• Alma Miranda
• Barbara Cox Miras
• Jennifer Miskabi
• Katelyn A Miskevics, LMFT
• Courtney Yvette Mitchell
• Maleek Andre Mitchell
• Mitsuaki David Kato, O.D., Inc.
• Torrey Mitsunaga, MS, RDN
• Dillon Miyasaki

• Federally Qualified Health Center (FQHC) in Culver City, CA
• Providers in Culver City, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.