QUEENSCARE HEALTH CENTERS (NPI# 1952716441) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1952716441 |
| Entity Type | Organization |
| Organization Name | QUEENSCARE HEALTH CENTERS |
| Practice Address |
4618 Fountain Ave Los Angeles CA 90029-1977 |
| Mailing Address |
950 S Grand Ave 2nd Floor South Los Angeles CA 90015-4202 |
| Practice Telephone | 3239537170 |
| Practice Fax Number | 3236692379 |
| Mailing Telephone | 3236694326 |
| Mailing Fax Number | 3239533658 |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2014-06-24 |
| Authorized Official Name | MS. BARBARA B. HINES (PRESIDENT AND CEO) |
| Authorized Official Telephone | 3236694305 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 333600000X | Pharmacy | Suppliers | ||
| Y | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDICARE FQHC PROVIDER NUMBER | 55-1895 | 01 |
| CA | MEDI-CAL FQHC PROVIDER NUMBER | FHC70660F | 01 |
| CA | CMM70660F | 05 | |
| CA | MEDICARE PROVIDER NUMBER | W6997D | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740835743 | Queenscare Health Centers | Clinic/Center | 303 Loma Dr, Los Angeles, CA 90017-1103 | 2019-08-06 |
| 1992106082 | Queenscare Health Centers | Pharmacy | 4816 E 3rd St, Los Angeles, CA 90022-1602 | 2014-09-09 |
| 1104075282 | Queenscare Health Centers | Clinic/Center | 4816 E 3rd St, Los Angeles, CA 90022-1602 | 2008-09-15 |
| 1013083666 | Queenscare Health Centers | Clinic/Center | 150 N Reno St, Los Angeles, CA 90026-4656 | 2006-11-27 |
| 1639241888 | Queenscare Health Centers | Clinic/Center | 4618 Fountain Ave, Los Angeles, CA 90029-1830 | 2006-11-14 |
| 1801967062 | Queenscare Health Centers | Clinic/Center | 4448 York Blvd, Los Angeles, CA 90041-3328 | 2006-11-10 |
| 1164593331 | Queenscare Health Centers | Clinic/Center | 133 N Sunol Dr, Los Angeles, CA 90063-1429 | 2006-11-10 |
| 1093886251 | Queenscare Health Centers | Clinic/Center | 184 Bimini Pl, Los Angeles, CA 90004-5903 | 2006-11-10 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | QUEENSCARE HEALTH CENTERS | 950 South Grand Ave Second Floor South, Los Angeles, CA 90015-4202 |
| Street Address |
4618 FOUNTAIN AVE |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90029-1977 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134198922 | Judy Jooyun Lee | Pediatrics | 4618 Fountain Ave, Los Angeles, CA 90029-1977 | 2006-03-15 |
| 1437701208 | David Angel Cortez | Nurse Practitioner | 4618 Fountain Ave, Los Angeles, CA 90029-1977 | 2019-07-11 |
| 1235697251 | Top Triamwong | Pharmacist | 4618 Fountain Ave, Los Angeles, CA 90029-1977 | 2019-03-08 |
| 1962976456 | Faith Amarachukwu Onwuka | Nurse Practitioner | 4618 Fountain Ave, Los Angeles, CA 90029-1977 | 2019-01-17 |
| 1043729825 | Erinn Lewis Carusetta | Nurse Practitioner | 4618 Fountain Ave, Los Angeles, CA 90029-1977 | 2017-09-25 |
| 1831628197 | Mehranz Hakimi | Pharmacist | 4618 Fountain Ave, Los Angeles, CA 90029-1977 | 2017-06-08 |
| 1407383532 | Kristie Nakatsuchi | Pharmacist | 4618 Fountain Ave, Los Angeles, CA 90029-1977 | 2017-05-19 |
| 1376083063 | Korina D Milian | Community Health Worker | 4618 Fountain Ave, Los Angeles, CA 90029-1977 | 2017-03-01 |
| 1619417359 | Sandra Marisol Guzman | Community Health Worker | 4618 Fountain Ave, Los Angeles, CA 90029-1977 | 2017-02-28 |
| 1174071799 | Yen Le | Nurse Practitioner | 4618 Fountain Ave, Los Angeles, CA 90029-1977 | 2016-09-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053884775 | Melrose Recovery, LLC. | Substance Abuse Rehabilitation Facility | 1253 N Commonwealth Ave, Los Angeles, CA 90029 | 2019-01-04 |
| 1548740939 | Mission City Community Network Inc | Clinic/Center | 5300 Santa Monica Blvd Ste 202, Los Angeles, CA 90029 | 2018-08-15 |
| 1215454707 | Dennis De Vera | Respiratory Therapist, Registered | 1154 N. Berendo St, Los Angeles, CA 90029 | 2017-08-24 |
| 1508390881 | Acadia Malibu, Inc. | Community/Behavioral Health | 4423 and 4423 1/2 Santa Monica Boulevard, Los Angeles, CA 90029 | 2017-04-13 |
| 1023556610 | Jasen Mcgoldrick | Substance Abuse Rehabilitation Facility | 4445 Burns Ave., Los Angeles, CA 90029 | 2017-02-03 |
| 1679930572 | Sukhwa Park | Acupuncturist | 4870 Santa Monica Blvd, Los Angeles, CA 90029 | 2016-01-22 |
| 1629326749 | Jocelyn Anne Brown | Midwife | 1042 Sanborn Ave Apt 9, Los Angeles, CA 90029 | 2012-08-21 |
| 1811211915 | Advanced Skilled Nursing Inc. | Skilled Nursing Facility | 975 North Virgil Avenue, Los Angeles, CA 90029 | 2010-03-17 |
| 1427244060 | Manuel Masaganda Ferreras | Technician/Technologist | 1131 N Vermont Ave Ste 101, Los Angeles, CA 90029 | 2007-09-18 |
| 1033321013 | Zhirayr Jerry Khoshoryan | Chiropractor | 1233 Vermont Ave., Suite 1b, Los Angeles, CA 90029 | 2007-05-04 |
| Find all providers in zip 90029 | ||||
| Taxonomy Code | 3336C0002X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Clinic Pharmacy |
| A pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision of a pharmacist. |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306263264 | University of Southern California | Pharmacy | 830 S Flower St, Los Angeles, CA 90017-4608 | 2014-03-27 |
| 1770797805 | Martin Luther Kingjr-multi-service Ambulatory Care Center | Pharmacy | 12021 South Wilmington Ave, Los Angeles, CA 90059 | 2007-05-09 |
| 1396867578 | County of Los Angeles - Auditor Controller | Pharmacy | 5850 S. Main St, Los Angeles, CA 90003-1215 | 2007-04-06 |
| 1649303306 | Women's & Children's Hospital Pharmacy | Pharmacy | 1240 N Mission Rd Trlr 7b, Los Angeles, CA 90033-1019 | 2007-03-13 |
| 1821146622 | Kaiser Foundation Health Plan Inc | Pharmacy | 1526 N Edgemont St Fl 1, Los Angeles, CA 90027-5260 | 2007-01-08 |
| 1033131107 | Aids Healthcare Foundation | Pharmacy | 1400 S Grand Ave Ste 801, Los Angeles, CA 90015-3068 | 2006-07-24 |
| 1215575873 | Lauren Andrea Tuason | Pharmacy | 1670 E 120th St, Los Angeles, CA 90059-3026 | 2019-12-13 |
| 1710437231 | San Vincente Women's Total Health Center Inc | Pharmacy | 6310 San Vicente Blvd, Suite 220, Los Angeles, CA 90048-5426 | 2016-10-07 |
| 1902355647 | East La Paz Family Medical Clinic Pa | Pharmacy | 3712 Whittier Blvd, Suite 1, Los Angeles, CA 90023-1733 | 2016-09-22 |
| 1558740852 | The Los Angeles Free Clinic | Pharmacy | 5205 Melrose Ave, Los Angeles, CA 90038-3144 | 2015-05-20 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90029 |
Please comment or provide details below to improve the information on QUEENSCARE HEALTH CENTERS.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.