MEDICARE: FAMILY MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	A67444	CA

General Provider Information

NPI Number	:	1205024718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	34052 LA PLZ
Second Line	:	SUITE 102
City	:	DANA POINT
State	:	CA
Zip	:	92629-2587
Country	:	US
Telephone Number	:	949-240-8555
Fax Number	:

Provider Business Practice Location Address
First Line	:	34052 LA PLZ
Second Line	:	SUITE 102
City	:	DANA POINT
State	:	CA
Zip	:	92629-2587
Country	:	US
Telephone Number	:	949-240-8555
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANUTA U DELNITZ
Credential	:	MD
Telephone Number	:	949-240-8555

Provider Enumeration Date	:	10/09/2007
Last Update Date	:	10/09/2007

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