Basic Information
| Provider Information | |||||||||
| NPI: | 1447865415 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN CALIFORNIA MEDICAL CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14550 HAYNES ST FL 3 | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914114116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184210809 | ||||||||
| FaxNumber: | 5626997066 | ||||||||
| Practice Location | |||||||||
| Address1: | 1627 E ANAHEIM ST | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908133809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5322188181 | ||||||||
| FaxNumber: | 5322188182 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2020 | ||||||||
| LastUpdateDate: | 11/02/2022 | ||||||||
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| AuthorizedOfficialLastName: | BUSHERI | ||||||||
| AuthorizedOfficialFirstName: | SHIELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5622188181 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | N | Agencies | Community/Behavioral Health | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QF0050X | N | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical | 122300000X | N | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dentist | 261QF0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 261QP2000X | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 261QR0206X | N | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mammography | 261QR1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Rural Health | 261QC1500X | Y | Ambulatory Health Care Facilities | Clinic/Center | Community Health |
No ID Information.