NPIMap

Organization Active NPI

University Muslim Medical Association Inc

  • Federally Qualified Health Center (FQHC)
  • Los Angeles, CA
National Provider Identifier
1720171242
Registry record updated May 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
UNIVERSITY MUSLIM MEDICAL ASSOCIATION INC
Practice address
711 W Florence Ave
Los Angeles, CA 90044
Phone
(323) 789-5610
Fax
(323) 789-5616
NPI assigned
Oct 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2024

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

Authorized official

Name
Alfredo Reynoso
Title
Chief Operating Officer
Phone
(323) 313-5588

Specialties & licenses 1

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

Addresses

Primary practice location

711 W Florence Ave
Los Angeles, CA 90044

Mailing address

711 W Florence Ave
Los Angeles, CA 90044
Phone (323) 789-5610

Other identifiers 6

IdentifierTypeStateIssuer
H701898OtherCAPUBLIC PRIVATE PARTNERSHI
051099OtherCAMEDICARE PROVIDER NUMBER
BCP70908FMedicaidCA
FHC70908FMedicaidCA
EAP70908FMedicaidCA
HAP70908FMedicaidCA

Other names 1

  • UMMA Community Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070420000311 CA Part A Provider - Federally Qualified Health Center (FQHC) 8628173564 Practice locations: Los Angeles, CA
O20240711001981 CA Part B Supplier - Clinic/Group Practice 8628173564 Receives reassigned benefits from 1 practitioner
3 other NPIs on this enrollment
Practice locations: Los Angeles, CA

Federally qualified health center certification: CCN 051099

Legal name
UNIVERSITY MUSLIM MEDICAL ASSOCIATION INC
Doing business as
UMMA COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 13, 2007
Last certification
Jun 13, 2007
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Dec 10, 1997 in CA
Enrollment address
711 W Florence Ave
Los Angeles, CA 90044-6105

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
University Muslim Medical Association Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Naim Shah Individual Corporate DirectorBoard Member Feb 1, 2012
Murtaza Sanwari Individual Corporate DirectorBoard Member Feb 1, 2012
Paul Wong Individual Corporate DirectorBoard Member Feb 1, 2012
Constance Biteye Individual W-2 Managing EmployeeCredentialing and Volunteer Coord. Jun 29, 2022 50%
Steonee Laskey Individual Corporate OfficerChief Operating Officer Jun 29, 2022
Munaf M Kadri Individual Corporate DirectorBoard Member Feb 1, 2012
Nadina Altamirano Individual Corporate DirectorBoard Member Feb 1, 2012
Norma a Arambula Individual Corporate DirectorBoard Member Feb 1, 2012
Raziya Shaikh Individual Corporate DirectorBoard Member Feb 1, 2012
Khaliq a Siddiq Individual Corporate DirectorBoard Member Feb 1, 2012
Vivianna Trujillo Individual Corporate Director Feb 1, 2012
Octavia Rogers Individual Corporate DirectorBoard Member Feb 1, 2012
Omar Gonzalez Individual Corporate DirectorBoard Member Feb 1, 2012

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716422400000",
    "number": "1720171242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 W FLORENCE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90044",
            "telephone_number": "323-789-5610",
            "fax_number": "323-789-5616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W FLORENCE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90044",
            "telephone_number": "323-789-5610",
            "fax_number": "323-789-5616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNIVERSITY MUSLIM MEDICAL ASSOCIATION INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2024-05-23",
        "certification_date": "2024-05-23",
        "status": "A",
        "authorized_official_last_name": "REYNOSO",
        "authorized_official_first_name": "ALFREDO",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "323-313-5588"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PUBLIC PRIVATE PARTNERSHI",
            "identifier": "H701898",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "051099",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "BCP70908F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70908F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "EAP70908F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HAP70908F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UMMA Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.