NPIMap

Organization Active NPI

Wilmington Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Wilmington, CA
National Provider Identifier
1932194586
Registry record updated Feb 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
WILMINGTON COMMUNITY CLINIC
Practice address
1009 N Avalon Blvd
Wilmington, CA 90744-4505
Phone
(310) 549-5760
Fax
(310) 549-2277
NPI assigned
Sep 20, 2005
Last updated
Feb 24, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2026

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

Authorized official

Name
Veronica Rodarte
Title
Revenue Cycle Manager
Phone
(310) 714-8521

Specialties & licenses 1

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

Addresses

Primary practice location

1009 N Avalon Blvd
Wilmington, CA 90744-4505

Mailing address

1009 N Avalon Blvd
Wilmington, CA 90744-4505
Phone (310) 549-5760

Other identifiers 1

IdentifierTypeStateIssuer
1932194586MedicaidCA

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100215000535 CA Part B Supplier - Clinic/Group Practice 2567506504 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
Practice locations: Wilmington, CA
O20141125002459 CA Part A Provider - Federally Qualified Health Center (FQHC) 2567506504 Practice locations: Wilmington, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932194586. Details of each certification follow.

Federally qualified health center certification: CCN 751136

Legal name
WILMINGTON COMMUNITY CLINIC
Organization structure
CorporationNon-profit
Incorporated
Apr 28, 1977 in CA
Enrollment address
1009 N Avalon Blvd
Wilmington, CA 90744-4505

National Provider Directory

National Provider Directory

Locations

1009 N Avalon Blvd
Wilmington, CA 90744
Phone (310) 549-5760

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Daniel Valdez Individual Corporate OfficerBoard Member Dec 19, 2013
Jaquelin Heredia Individual W-2 Managing EmployeeCredentialing Coordinator Jul 2, 2021 100%
Veronica Rodarte Individual W-2 Managing EmployeeRevenue Cycle Manager Jun 25, 2024
Yamilett Medrano Individual Corporate OfficerSecretary May 1, 2016
Grant Reed Individual Corporate OfficerBoard Chair Jun 23, 2011
Xylina D Bean Individual Corporate OfficerBoard Member Jul 1, 2006
Luis Morales Individual Corporate OfficerBoard Member Apr 20, 2022
Sheril Garzon Individual Corporate OfficerBoard Member Oct 24, 2019
Deborah Lerner Individual W-2 Managing EmployeeCeo Jun 25, 2024
Diane Kaler Individual Corporate OfficerTreasurer Aug 15, 2017
Byron Lane Individual Corporate OfficerVice Chair Oct 25, 2018

Owners & managing parties with NPI records 2

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

Subparts reporting this organization as parent 3

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771891200000",
    "number": "1932194586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1009 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907444505",
            "telephone_number": "310-549-5760",
            "fax_number": "310-549-1453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1009 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907444505",
            "telephone_number": "310-549-5760",
            "fax_number": "310-549-2277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILMINGTON COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-20",
        "last_updated": "2026-02-24",
        "certification_date": "2026-02-24",
        "status": "A",
        "authorized_official_last_name": "RODARTE",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "310-714-8521"
    },
    "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": "1932194586",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, CA

Sources for this page

Verify at the official NPI Registry.