MEDICARE: FIRST CHOICE PHYSICIAN PARTNERS

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	152W00000X	Optometrist
2	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1376378257
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE PHYSICIAN PARTNERS

Provider Business Mailing Address
First Line	:	1520 N GRAND AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-2627
Country	:	US
Telephone Number	:	714-558-1385
Fax Number	:	714-558-7269

Provider Business Practice Location Address
First Line	:	1520 N GRAND AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-2627
Country	:	US
Telephone Number	:	714-558-1385
Fax Number	:	714-558-7269

Authorized Official
Title or Position	:	VP, CFO TPR
Name	:	BRIAN RASMUS
Credential	:
Telephone Number	:	469-893-2532

Provider Enumeration Date	:	09/03/2024
Last Update Date	:	09/03/2024

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