MEDICARE: YORBA LINDA FAMILY PHYSICIANS, A MEDICAL GROUP, 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	363AM0700X	Medical Physician Assistant		CA
2	207Q00000X	Family Medicine Physician		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05D0954510	OTHER	CA	CLIA NUMBER
2	ZZZ56875Z	OTHER	CA	BLUE SHIELD OF CALIFORNIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295782423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YORBA LINDA FAMILY PHYSICIANS, A MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	18200 YORBA LINDA BLVD
Second Line	:	SUITE 401
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-4056
Country	:	US
Telephone Number	:	714-646-8000
Fax Number	:	714-572-2562

Provider Business Practice Location Address
First Line	:	18300 YORBA LINDA BLVD
Second Line	:	SUITE 201
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-4052
Country	:	US
Telephone Number	:	714-577-6000
Fax Number	:	714-572-2562

Authorized Official
Title or Position	:	PRESIDENT
Name	:	THOMAS BARKER
Credential	:	M.D.
Telephone Number	:	714-646-8000

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	04/10/2015

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