Provider Demographics
NPI:1972908044
Name:COMMUNITY SUPPORT CLINIC, INC.
Entity type:Organization
Organization Name:COMMUNITY SUPPORT CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MALEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-373-3350
Mailing Address - Street 1:147 N SPARKS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2143
Mailing Address - Country:US
Mailing Address - Phone:323-373-3350
Mailing Address - Fax:323-373-3351
Practice Address - Street 1:506 S SAN PEDRO ST
Practice Address - Street 2:SUITE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-2102
Practice Address - Country:US
Practice Address - Phone:323-373-3350
Practice Address - Fax:323-373-3351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-30
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical