Healthcare Provider Details

I. General information

NPI: 1144608779
Provider Name (Legal Business Name): FAMILY MEDICAL AND OCCUPATIONAL CLINICS IN CA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA PALMA AVE STE 10
ANAHEIM CA
92801-2805
US

IV. Provider business mailing address

1120 W LA PALMA AVE STE 10
ANAHEIM CA
92801-2805
US

V. Phone/Fax

Practice location:
  • Phone: 714-774-0754
  • Fax: 714-774-0119
Mailing address:
  • Phone: 714-774-0754
  • Fax: 714-774-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA42255
License Number StateCA

VIII. Authorized Official

Name: DR. GEORGE FOUAD YOUSSEF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-774-0754