Healthcare Provider Details

I. General information

NPI: 1184941718
Provider Name (Legal Business Name): ANAHEIM FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 S ANAHEIM BLVD STE 270
ANAHEIM CA
92805-5584
US

IV. Provider business mailing address

947 S ANAHEIM BLVD STE 270
ANAHEIM CA
92805-5584
US

V. Phone/Fax

Practice location:
  • Phone: 714-535-1415
  • Fax: 714-533-0237
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GERARDO CANCHOLA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-535-1415