Provider Demographics
NPI:1073310355
Name:CENTRO MEDICO COMMUNITY CLINIC, INC
Entity type:Organization
Organization Name:CENTRO MEDICO COMMUNITY CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MASRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-241-6861
Mailing Address - Street 1:1303 W 6TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3196
Mailing Address - Country:US
Mailing Address - Phone:951-278-8910
Mailing Address - Fax:
Practice Address - Street 1:11900 AVALON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90061-2867
Practice Address - Country:US
Practice Address - Phone:951-278-8910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRO MEDICO COMMUNITY CLINIC, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)