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NPI Code Detail

MEDICARE: FAMILY CARE SPECIALISTS MEDICAL CORPORATION

MEDICARE: FAMILY CARE SPECIALISTS MEDICAL CORPORATION
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
1207Q00000XFamily Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CQ2165OTHERGARAILROAD MEDICARE GROUP
3W10759AOTHERCAMEDICARE GROUP ID

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2ZZZ22101ZOTHERCABLUE SHIELD GROUP ID
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740233725
Entity Type Code : Organization
Provider Name (Legal Business Name) : FAMILY CARE SPECIALISTS MEDICAL CORPORATION
Provider Business Mailing Address
First Line : 5823 YORK BLVD STE 3
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-2634
Country : US
Telephone Number : 323-317-9200
Fax Number : 323-254-2158
Provider Business Practice Location Address
First Line : 815 WASHINGTON BLVD
Second Line :
City : MONTEBELLO
State : CA
Zip : 90640-6123
Country : US
Telephone Number : 323-317-9200
Fax Number : 323-728-6905
Authorized Official
Title or Position : CHIEF MEDICAL OFFICER
Name : MAURICIO EDUARDO BUENO
Credential : MD
Telephone Number : 323-791-0557
Provider Enumeration Date : 05/18/2006
Last Update Date : 03/31/2026

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Directions to “FAMILY CARE SPECIALISTS MEDICAL CORPORATION ” Practice Location

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