Mission City Community Network, Inc.
Organization Active NPI Community Health Clinic/Center · North Hills, CA
NPI 1710370747 · NPPES record last updated Jul 18, 2017
Key facts
- NPI
- 1710370747
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Health Clinic/Center 261QC1500X
- Legal business name
- MISSION CITY COMMUNITY NETWORK, INC.
- Practice address
- 8527 Sepulveda Blvd
North Hills, CA 91343-5824 - Phone
- (818) 895-3100
- Fax
- (818) 893-9464
- NPI assigned
- Mar 16, 2015
- Organization subpart
- Yes
- Parent organization (as reported)
- MISSION CITY COMMUNITY NETWORK, INC.
Authorized official
- Name
- Nik Gupta
- Title
- Ceo
- Phone
- (818) 895-3100
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 18
Corporate family (same tax ID) 17
Practitioners 150
-
Martha Patricia Buckley, O.D.
-
Jennifer Siao Lim, M.D.
-
Paul Malabanan, MD
-
Jacob Noghreian, M.D.
-
Oluwatoyin Oladimeji, DNP/PMHNP-BC
-
Shobha Sharma, NURSE PRACTITIONER
-
Vinod Sodha, MD
-
Alycia Erin Wood, LCSW
-
Mahin Ghanevati, D.O., PH.D., M.S.
-
Janet Agu, NP
-
Rosa Maria Aguero, DNP, PMHNP
-
Owen Akenzua, LCSW
-
Jessie Alvarez, PMHNP-BC
-
Ethel Antonio, NP
-
Alete S Arom, PSY.D.
-
Yaw O Asamoah, PA-C
-
Rishika Bhoolabhai, DDS
-
Aram Bonni, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA
Federally qualified health center certification: CCN 751952
- Legal name
- MISSION CITY COMMUNITY NETWORK, INC.
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Feb 21, 2017
- Last certification
- Feb 21, 2017
- Ownership / control type
- For profit – corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 6, 1989 in CA
- Enrollment address
- 8527 Sepulveda Blvd
North Hills, CA 91343-5824
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Maria Chaudhry |
Corporate Director |
Dec 1, 2012 | |
| Nik Gupta |
Corporate Officer | Mar 16, 2001 | |
| Corporate Director |
Jul 1, 2009 | ||
| W-2 Managing Employee |
Jul 1, 2009 | ||
| Frank Gonzales |
Corporate Director |
Jun 13, 2017 | |
| Aida Vlught |
Corporate Director |
Jul 1, 2000 | |
| Norma J Solis |
Corporate Director |
Jun 30, 2021 | |
| Sammy Riley |
Corporate Director |
Feb 23, 2021 | |
| Mark Berry |
Corporate Director |
Aug 19, 2017 | |
| Adriana Guzman |
Corporate Director |
Mar 17, 2014 | |
| Magdalena Almira |
Corporate Officer |
Feb 20, 2007 | |
| Rosalind Scarbrough |
Corporate Director |
Feb 23, 2021 | |
| Derek Biesheuvel |
Corporate Director |
Mar 17, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040204000544 | CA | Part B Supplier - Clinic/Group Practice | 1658264684 |
Receives reassigned benefits from 152 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: North Hills, CA; Northridge, CA; Victorville, CA |
| O20170322002328 | CA | Part a Provider - Federally Qualified Health Center (FQHC) | 1658264684 | Practice locations: North Hills, CA |
National Provider Directory
- Tax ID family
- Mission City Community NTWK
- Part of
- Mission City Community NTWK
Locations
401 E Buena Vista St
Barstow, CA 92311
405 E Buena Vista St
Barstow, CA 92311
9808 Venice Blvd
Ste 404
Culver City, CA 90232
Phone (310) 556-0702
359 N Fairfax Ave
Los Angeles, CA 90036
513 E Lime Ave
Ste 103
Monrovia, CA 91016
Phone (626) 357-2605
8363 Reseda Blvd
Ste 11
Northridge, CA 91324
Phone 8188953100602
15201 Eleventh St
Ste 300
Victorville, CA 92395
Phone (760) 245-1640
3220 N Bronco St
Las Vegas, NV 89108
Phone 8188953100611
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Health Clinic/Center | 261QC1500X | Yes |
Addresses
Primary practice location
8527 Sepulveda Blvd
North Hills, CA 91343-5824
Mailing address
8527 Sepulveda Blvd
North Hills, CA 91343-5824
Phone (818) 895-3100
Other names
- Mission City Community Network Inc.
Other providers in North Hills, CA
- Dina Mismar
- Mission City Community Network Inc
- Mission City Community Network Inc
- Mission City Community Network, Inc - Community Pharmacy
- Mission City Community Network, Inc.
- Mission City Community Network, Inc.
- Mission City Communuty Network, Inc
- Puja Mistry
- Alex Moiseyev
- Abigail Kimberley Mojica-Ramirez
All providers in North Hills, CA · Community Health Clinic/Center in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2017. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.