Provider Demographics
NPI:1649090150
Name:WHITE MEMORIAL COMMUNITY HEALTH CENTER
Entity type:Organization
Organization Name:WHITE MEMORIAL COMMUNITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-CMO
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOUTSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-987-1200
Mailing Address - Street 1:1828 E CESAR E CHAVEZ AVE STE 6100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2597
Mailing Address - Country:US
Mailing Address - Phone:323-859-3627
Mailing Address - Fax:323-987-1212
Practice Address - Street 1:1701 E CESAR E CHAVEZ AVE STE 456
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2496
Practice Address - Country:US
Practice Address - Phone:323-987-1200
Practice Address - Fax:323-987-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty