South Central Family Health Center
Organization Active NPI Federally Qualified Health Center (FQHC) · Huntington Park, CA
NPI 1669799896 · NPPES record last updated Jan 25, 2012
Key facts
- NPI
- 1669799896
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- SOUTH CENTRAL 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
- Organization subpart
- No
Authorized official
- Name
- Mr. Richard A Veloz, JD,MPH
- Title
- Chief Executive Officer
- Phone
- (323) 908-4247
Owners & managing parties with NPI records 1
-
Jose L Perez, M.D.
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 7
Practitioners 41
-
Lydia Chua Aguilera, M.D.
-
Jaime Botero, LCSW
-
Alexander Lim Cheng, M.D.
-
Bobby Jerome Davis, LCSW 24919
-
Lyanne Daisy Duarte, FNP-BC
-
Sergio Figueroa Aragon, M.D.
-
Sunitha Gill, M.D
-
Kristin Woolley, M.D.
-
Victor Arias, MD
-
Rory L. Butler, PA
-
Sara Camarena, PA-C
-
Carmen G Diaz, PA-C
-
Mina H Hakim, MD
-
Christopher Aaron Ifekwunigwe, L.C.S.W.
-
Romar Bagang Lingad, FNP, MSN, RN
-
Vanesa Lovato, RN, NP
-
Grace R Neuman, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D1079213 | Huntington Park Family Health Center | Provider-performed microscopy | Dec 14, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
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
- Corporation · Non-profit
- Incorporated
- Apr 15, 1983 in CA
- Enrollment address
- 2680 Saturn Ave, Ste 110
Huntington Park, CA 90255-4569
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Elmer G Roldan |
Corporate Director |
Jun 29, 2016 | |
| Jaime Moreno |
Corporate Director |
Mar 4, 2016 | |
| Jose L Perez |
Corporate Officer |
Mar 16, 2017 | |
| Adrian Devargas |
Corporate Director |
Jan 3, 2017 | |
| Martha Munoz |
Corporate Director |
Apr 15, 2013 | |
| Genevieve Filmardirossian |
Corporate Officer |
Mar 1, 2024 | |
| W-2 Managing Employee | Mar 1, 2024 | ||
| Tia Strozier |
Corporate Director |
Nov 8, 2016 | |
| Paul Ramos |
Corporate Officer |
Aug 1, 2002 | |
| W-2 Managing Employee | Jan 24, 2011 | ||
| Janice R Brittain |
Corporate Officer |
Feb 26, 2013 | |
| Fernando Almodovar |
Corporate Director |
Jul 15, 2011 | |
| Tumani S Moore-Leatherwood |
Corporate Director |
May 27, 2009 | |
| Rosie Rios |
Corporate Director |
May 27, 2008 | |
| Erica Y Hernandez |
Corporate Director |
Oct 1, 2014 | |
| Amir a Johnson |
Corporate Director |
Nov 4, 2014 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| South Central Family Health Center-Vernon |
Federally qualified health center | Operational/Managerial Control | Jul 31, 2012 |
| Cudahy Family Health Center |
Federally qualified health center | Operational/Managerial Control (100%) | Nov 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- South Central Family Health
Locations
2680 Saturn Ave
Ste 220280
Huntington Park, CA 90255
2680 Saturn Ave
Ste 110
Huntington Park, CA 90255
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669799896 | Medicaid | CA |
Other names
- Huntington Park Family Health Center
Other providers in Huntington Park, CA
- Yadira A Sotalin
- Amanda Soto
- South Atlantic Medical Group
- South Central Family Health Center
- South Central Family Health Center
- South Coast Surgery Center Inc
- Southern California Podiatry Group, Inc.
- Southern California Surgery Center, Inc
- Southwestern Anesthesia Group (Swag)
- Damani Spearman
All providers in Huntington Park, CA · Federally Qualified Health Center (FQHC) in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2012. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.