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SANDY SEGAL YOUTH HEALTH CENTER
NPI 1417490236
Clinic/Center - Federally Qualified Health Center (FQHC) in Culver City, CA

Active since November 28, 2016CLIA 05D0711011 · Microscopy
4401 ELENDA ST, CULVER CITY, CA 90230(310) 392-8636 Get Directions Write a Review

NPPES record last updated: September 11, 2023. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Sep 29, 2021, Apr 19, 2021, Jan 20, 2017 (3 updates tracked since 2017).

About Sandy Segal Youth Health Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SANDY SEGAL YOUTH HEALTH CENTER (NPI 1417490236) is a healthcare organization registered as a federally qualified health center (fqhc) in Culver City, California and active in the NPI registry since November 2016. The organization holds a CLIA Microscopy certificate valid through December 5, 2026 and lists Mitesh G Popat, Chief Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1417490236
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NameVENICE FAMILY CLINIC
Location Address4401 ELENDA STCulver City, CA 90230-4101
Mailing Address604 Rose AveVenice, CA 90291-2767 · (310) 392-8636
Phone(310) 392-8636
Organization SubpartYes
Authorized OfficialMitesh G PopatChief Executive Officer · (310) 664-7901
Enumeration DateNovember 28, 2016
Last NPPES UpdateSeptember 11, 20233 updates tracked since enumeration
NPPES CertifiedSeptember 11, 2023
✔ NPI 1417490236 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedClinic/Center · Community HealthTaxonomy 261QC1500X
4401 ELENDA ST, Culver City, CA 90230
Open in Google Maps ↗

Other Names 1

Other NameSandy Segal Youth Health Center

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D0711011

Sandy Segal Youth Health Center · Culver City, CA
Active · expires Dec 5, 2026
CLIA Number05D0711011
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateDecember 6, 2024
Certificate Expiration DateDecember 5, 2026
Laboratory DirectorBlanca G. Andres
Laboratory Phone(310) 664-7667
Laboratory LocationSandy Segal Youth Health Center4401 Elenda St, Culver City, CA 90230
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LYDIA JOY ENGLAND
Student in an Organized Health Care Education/Training Program
4401 ELENDA ST
CULVER CITY, CA 90230
Los Angeles County (310) 664-7788
DIANNA S CASTRO RN, MSN, NCSN
Registered Nurse (School)
4401 ELENDA ST
CULVER CITY, CA 90230
Los Angeles County (310) 842-4200
JESSICA L PAREL RN-BSN, CSN, PHN
Registered Nurse (School)
4401 ELENDA ST
CULVER CITY, CA 90230
Los Angeles County (310) 842-4200
CHUNGYUN SEO MSW TRAINEE
Student in an Organized Health Care Education/Training Program
4401 ELENDA ST
CULVER CITY, CA 90230
Los Angeles County (310) 392-8636
WILLIAM RICHARD TERESA
Student in an Organized Health Care Education/Training Program
4401 ELENDA ST
CULVER CITY, CA 90230
Los Angeles County (310) 664-7788
SANDY AGUILA RN
Registered Nurse (Community Health)
4401 ELENDA ST
CULVER CITY, CA 90230
Los Angeles County (310) 842-4200

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Venice Family Clinic's NPI number?

The NPI number for Venice Family Clinic is 1417490236. It was assigned to this organization in the NPPES registry on November 28, 2016. The provider is also known as Sandy Segal Youth Health Center.

Where is Venice Family Clinic located?

Venice Family Clinic is located at 4401 Elenda St, Culver City, CA 90230. The listed phone number is (310) 392-8636.

What is Venice Family Clinic's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Does Venice Family Clinic hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 05D0711011) is associated with this NPI, valid through December 5, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Venice Family Clinic was last updated on September 11, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.