NPIMap

Organization Active NPI

White Memorial Community Health Center

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1649090150
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
WHITE MEMORIAL COMMUNITY HEALTH CENTER
Practice address
1701 E Cesar E Chavez Ave Ste 456
Los Angeles, CA 90033-2496
Phone
(323) 987-1200
Fax
(323) 987-1212
NPI assigned
Oct 10, 2024
Last updated
Oct 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Authorized official

Name
Grace FloutsisNPI 1518053735
Title
Ceo-Cmo
Phone
(323) 987-1200

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X

Addresses

Primary practice location

1701 E Cesar E Chavez Ave Ste 456
Los Angeles, CA 90033-2496

Mailing address

1828 E Cesar E Chavez Ave Ste 6100
Los Angeles, CA 90033-2597
Phone (323) 859-3627

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250922001728 CA Part A Provider - Federally Qualified Health Center (FQHC) 7315218260 Practice locations: Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649090150. Details of each certification follow.

Federally qualified health center certification: CCN A11000

Legal name
WHITE MEMORIAL COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 14, 2025
Last certification
Oct 14, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
1701 E Cesar E Chavez Ave
Ste 456
Los Angeles, CA 90033-2496

Other NPIs with the same Medicare PAC ID 3

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

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
05D2127751White Memorial Community Health Center1701 East Cesar E Chavez Ave Ste 456, Los Angeles, CA 90033Certificate of waiverMar 16, 2027

National Provider Directory

National Provider Directory
Tax ID family
White Memorial Community Health Center3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1828 E Cesar E Chavez Ave
Ste 4100
Los Angeles, CA 90033
Phone (323) 859-3630

1828 E Cesar E Chavez Ave
Ste 6100
Los Angeles, CA 90033
Phone (323) 859-3627

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Joselyn Rivas Individual Corporate DirectorBoard of Directors Jan 15, 2017
Elisa Dominguez Individual Corporate DirectorBoard of Directors Dec 16, 2021
Nadia Aguilar Individual Corporate DirectorBoard of Directors May 4, 2023
Raul Salinas Individual Corporate DirectorBoard of Directors Mar 4, 2021
George Ramirez Individual Corporate DirectorBoard of Directors Jan 13, 2015
Norma Osorio Individual Corporate DirectorBoard of Directors Jan 13, 2015
Elizabeth Aleman Individual Corporate DirectorBoard of Directors Jan 5, 2017
Grace K Floutsis Individual W-2 Managing EmployeeCeo May 1, 2020
Ergueen Herrera Individual Corporate DirectorBoard of Directors Jan 13, 2015
John Raffoul Individual Corporate DirectorBoard of Directors Jan 13, 2015
White Memorial Community Health Center Organization, Los Angeles, CA Corporation, Non-profit Other Jan 1, 2017
Yolanda T Rangel Individual Corporate DirectorBoard of Directors May 1, 2017
David C Lizarraga Individual Corporate DirectorBoard of Directors Jan 13, 2015
Ruben Maciel Individual Corporate DirectorBoard of Directors May 1, 2021
Ana I Grande Individual Corporate DirectorBoard of Directors Nov 1, 2018

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
White Memorial Community Health CenterLos Angeles, CA, CCN 921063 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 13, 2015
White Memorial Community Health CenterLos Angeles, CA, CCN 921110 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 13, 2015
White Memorial Community Health CenterLos Angeles, CA, CCN A01875 Federally qualified health center 5% Or Greater Direct Ownership Interest Jan 13, 2015

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1728518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1649090150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1828 E CESAR E CHAVEZ AVE STE 6100",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332597",
            "telephone_number": "323-859-3627",
            "fax_number": "323-987-1212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E CESAR E CHAVEZ AVE STE 456",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900332496",
            "telephone_number": "323-987-1200",
            "fax_number": "323-987-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE MEMORIAL COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-10",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "FLOUTSIS",
        "authorized_official_first_name": "GRACE",
        "authorized_official_title_or_position": "CEO-CMO",
        "authorized_official_telephone_number": "323-987-1200"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.