Healthcare Provider Details

I. General information

NPI: 1568890085
Provider Name (Legal Business Name): FAMILY MEDICAL CLINICS OF CALIFORNIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 10/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 N STATE COLLEGE BLVD
ANAHEIM CA
92806-2702
US

IV. Provider business mailing address

1077 N STATE COLLEGE BLVD
ANAHEIM CA
92806-2702
US

V. Phone/Fax

Practice location:
  • Phone: 714-533-4362
  • Fax:
Mailing address:
  • Phone: 714-533-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA42255
License Number StateCA

VIII. Authorized Official

Name: DR. GEORGE YOUSSEF
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 714-533-4362