VENICE FAMILY CLINIC – NPI #1558934059
Clinic/Center

VENICE FAMILY CLINIC is an AHC clinic located in INGLEWOOD, CA. NPPES has assigned the NPI number 1558934059 to VENICE FAMILY CLINIC on July 21, 2021. It is a Type-2 NPI, indicating this NPI number is associated with an organization. VENICE FAMILY CLINIC is also known by the name VENICE SOUTH BAY INGLEWOOD. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 261QF0400X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Federally Qualified Health Center (FQHC)

The NPI profile was previously updated about 3 years ago on Nov 30, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for VENICE FAMILY CLINIC below.

NPI Profile for
VENICE FAMILY CLINIC

NPI Number
1558934059
Enumeration Date

(about 5 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
VENICE FAMILY CLINIC
Other Name: VENICE SOUTH BAY INGLEWOOD
Primary location
1091 S LA BREA AVE
INGLEWOOD, CA 90301-3817
Phone: (310) 802-6177 Fax: (310) 802-6178
Mailing address
604 ROSE AVE
VENICE, CA 90291-2767
Phone: (310) 392-8636 Fax:
Organization Subpart
Yes - VENICE FAMILY CLINIC is subpart of another organization.
Authorized Official
MITESH POPAT
CHIEF EXECUTIVE OFFICER
Phone: (310) 664-7901
Updated
Certification Date
Nov 30, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QF0400X
- Clinic/Center / Federally Qualified Health Center (FQHC) (Primary)
171M00000X
- Case Manager/Care Coordinator

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.