South Bay Family Healthcare Center

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

SOUTH BAY FAMILY HEALTHCARE CENTER

Practice address

742 W Gardena Blvd
Gardena, CA 90247-5024

Phone

(310) 802-6177

Fax

(310) 802-6178

NPI assigned

Feb 8, 2007

Organization subpart

No

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

Authorized official

Name

Jann Hamiliton-Lee

Title

President-Ceo

Phone

(310) 802-6177

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Venice Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Gardena, CA
  • NPI 1184297681

  Sold to, 2021-11-01

  CMS change of ownership

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191542400000",
    "number": "1871634568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23430 HAWTHORNE BLVD",
            "address_2": "BLDG 3, SUITE 210",
            "city": "TORRANCE",
            "state": "CA",
            "postal_code": "905054720",
            "telephone_number": "310-802-6177",
            "fax_number": "310-802-6178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "742 W GARDENA BLVD",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902475024",
            "telephone_number": "310-802-6177",
            "fax_number": "310-802-6178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BAY FAMILY HEALTHCARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-08",
        "last_updated": "2007-10-05",
        "status": "A",
        "authorized_official_last_name": "HAMILITON-LEE",
        "authorized_official_first_name": "JANN",
        "authorized_official_title_or_position": "PRESIDENT-CEO",
        "authorized_official_telephone_number": "310-802-6177"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FAMPACT",
            "identifier": "HAP70093F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "FHC70093F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lynn Soto
• Monica Cecilia Soto
• Chantal Sotomayor, OTR
• South Atlantic Medical Group
• South Bay Companies Group, Inc.
• South Bay Senior Health, Inc.
• Southbay Advance Medical Group, Inc.
• Emily Parrish Southwell, DPT
• Samantha Jane Spadaro, NONE
• Cheryl Sparks

• Federally Qualified Health Center (FQHC) in Gardena, CA
• Providers in Gardena, CA by specialty
• Federally Qualified Health Center (FQHC) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.