NPIMap

Organization Active NPI

Mission City Community Network, Inc.

Doing business as Mission City Community Network, Inc.-La Puente

  • Clinic/Center
  • La Puente, CA
National Provider Identifier
1942694096
Registry record updated Jun 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
MISSION CITY COMMUNITY NETWORK, INC.
Doing business as
Mission City Community Network, Inc.-La Puente
Practice address
1025 Willow Ave
La Puente, CA 91746-1617
Phone
(818) 895-3100
Fax
(818) 893-9464
NPI assigned
Mar 26, 2015
Last updated
Jun 1, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2015

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

Authorized official

Name
Ms. Gloria Lina
Title
Coo
Phone
(818) 895-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X CA Primary

Addresses

Primary practice location

1025 Willow Ave
La Puente, CA 91746-1617

Mailing address

15206 Parthenia St
North Hills, CA 91343-5305
Phone (818) 895-3100

Other names 1

  • Mission City Community Network, Inc.-La Puente Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160428001030 CA Part A Provider - Federally Qualified Health Center (FQHC) 1658264684 Practice locations: La Puente, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942694096. Details of each certification follow.

Federally qualified health center certification: CCN 751853

Legal name
MISSION CITY COMMUNITY NETWORK, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 19, 2016
Last certification
Apr 19, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 6, 1989 in CA
Enrollment address
1025 Willow Ave
La Puente, CA 91746-1617

Other NPIs with the same Medicare PAC ID 18

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

View all 18

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2098850Mission City Community Network, Inc1025 Willow Ave, La Puente, CA 91746Certificate of waiverJul 14, 2027

National Provider Directory

National Provider Directory

Locations

1025 Willow Ave
La Puente, CA 91746
Phone (562) 960-6666

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
Nik Gupta Individual Corporate OfficerCeo Mar 16, 2001
W-2 Managing EmployeeCeo Jul 1, 2009
Frank Gonzales Individual Corporate DirectorBoard Member Jun 13, 2017
Aida Vlught Individual Corporate DirectorBoard Member Jul 1, 2000
Norma J Solis Individual Corporate Director Jun 30, 2021
Maria Chaudhry Individual Corporate DirectorBoard Member Dec 1, 2012
Sammy Riley Individual Corporate DirectorBoard Member Feb 23, 2021
Mark Berry Individual Corporate DirectorBoard Member Aug 19, 2017
Adriana Guzman Individual Corporate DirectorBoard Member Mar 17, 2014
Magdalena Almira Individual Corporate OfficerCfo - Chief Financial Officer Feb 20, 2007
Rosalind Scarbrough Individual Corporate DirectorBoard Member Feb 23, 2021
Derek Biesheuvel Individual Corporate DirectorBoard Member Mar 17, 2014

NPI Registry JSON

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

{
    "created_epoch": "1427328000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433116800000",
    "number": "1942694096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15206 PARTHENIA ST",
            "city": "NORTH HILLS",
            "state": "CA",
            "postal_code": "913435305",
            "telephone_number": "818-895-3100",
            "fax_number": "818-893-9464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 WILLOW AVE",
            "city": "LA PUENTE",
            "state": "CA",
            "postal_code": "917461617",
            "telephone_number": "818-895-3100",
            "fax_number": "818-893-9464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION CITY COMMUNITY NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-26",
        "last_updated": "2015-06-01",
        "status": "A",
        "authorized_official_last_name": "LINA",
        "authorized_official_first_name": "GLORIA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "818-895-3100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mission City Community Network, Inc.-La Puente",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Puente, CA

Sources for this page

Verify at the official NPI Registry.