NPIMap

Organization Active NPI

South Central Family Health Center

Doing business as Huntington Park Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Huntington Park, CA
National Provider Identifier
1669799896
Registry record updated Jan 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTH CENTRAL FAMILY HEALTH CENTER
Doing business as
Huntington Park Family Health Center
Practice address
2680 Saturn Ave Ste 220&280
Huntington Park, CA 90255-4377
Phone
(323) 908-4200
Fax
(323) 908-4256
NPI assigned
Apr 28, 2010
Last updated
Jan 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2012

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

Authorized official

Name
Mr. Richard A Veloz, JD,MPH
Title
Chief Executive Officer
Phone
(323) 908-4247

Specialties & licenses 1

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

Addresses

Primary practice location

2680 Saturn Ave Ste 220&280
Huntington Park, CA 90255-4377

Mailing address

4425 S Central Ave
Los Angeles, CA 90011-3629
Phone (323) 908-4200

Other identifiers 1

IdentifierTypeStateIssuer
1669799896MedicaidCA

Other names 1

  • Huntington Park Family Health Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110211000438 CA Part A Provider - Federally Qualified Health Center (FQHC) 5597675041 Practice locations: Huntington Park, CA
O20240621003215 CA Part B Supplier - Clinic/Group Practice 5597675041 Receives reassigned benefits from 35 practitioners
6 other NPIs on this enrollment
Practice locations: Huntington Park, CA; Cudahy, CA; Montebello, CA; Los Angeles, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669799896. Details of each certification follow.

Federally qualified health center certification: CCN 551073

Legal name
SOUTH CENTRAL FAMILY HEALTH CENTER
Doing business as
HUNTINGTON PARK FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 11, 2011
Last certification
Feb 11, 2011
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 15, 1983 in CA
Enrollment address
2680 Saturn Ave, Ste 110
Huntington Park, CA 90255-4569

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 6

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

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
05D1079213Huntington Park Family Health Center2680 Saturn Ave Ste 110, Huntington Park, CA 90255Provider-performed microscopyDec 14, 2027

National Provider Directory

National Provider Directory
Tax ID family
South Central Family Health Center8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

2680 Saturn Ave
Ste 220280
Huntington Park, CA 90255

7300 Santa Fe Ave
Huntington Pk, CA 90255
Phone (323) 277-8900

4425 S Central Ave
Los Angeles, CA 90011

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Elmer G Roldan Individual Corporate DirectorBoard Member Jun 29, 2016
Jaime Moreno Individual Corporate DirectorBoard Member Mar 4, 2016
Jose L Perez Individual Corporate OfficerChief Medical Officer Mar 16, 2017
Adrian Devargas Individual Corporate DirectorBoard Member Jan 3, 2017
Martha Munoz Individual Corporate DirectorBoard Member Apr 15, 2013
Genevieve Filmardirossian Individual Corporate OfficerChief Executive Officer Mar 1, 2024
W-2 Managing Employee Mar 1, 2024
Tia Strozier Individual Corporate DirectorBoard Member Nov 8, 2016
Paul Ramos Individual Corporate OfficerCfo Aug 1, 2002
W-2 Managing Employee Jan 24, 2011
Janice R Brittain Individual Corporate OfficerBoard Member Feb 26, 2013
Fernando Almodovar Individual Corporate DirectorBoard Chair Jul 15, 2011
Tumani S Moore-Leatherwood Individual Corporate DirectorBoard Vice Chair May 27, 2009
Rosie Rios Individual Corporate DirectorBoard Member May 27, 2008
Erica Y Hernandez Individual Corporate DirectorBoard Secretary Oct 1, 2014
Amir a Johnson Individual Corporate DirectorBoard Treasurer Nov 4, 2014

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
South Central Family Health Center-VernonLos Angeles, CA, CCN 921013 Federally qualified health center Operational/Managerial Control Jul 31, 2012
Cudahy Family Health CenterCudahy, CA, CCN 921079 Federally qualified health center Operational/Managerial Control (100%) Nov 1, 2016

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 36

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 36

NPI Registry JSON

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

{
    "created_epoch": "1272412800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327449600000",
    "number": "1669799896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 S CENTRAL AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900113629",
            "telephone_number": "323-908-4200",
            "fax_number": "323-908-4256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2680 SATURN AVE STE 220&280",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902554377",
            "telephone_number": "323-908-4200",
            "fax_number": "323-908-4256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH CENTRAL FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-28",
        "last_updated": "2012-01-25",
        "status": "A",
        "authorized_official_last_name": "VELOZ",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "323-908-4247",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "JD,MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1669799896",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Huntington Park Family Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Huntington Park, CA

Sources for this page

Verify at the official NPI Registry.