Healthcare Provider Details

I. General information

NPI: 1235322694
Provider Name (Legal Business Name): FAMILY PRACTICE PHYSICIANS A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20932 BROOKHURST ST SUITE 101
HUNTINGTON BEACH CA
92646-6638
US

IV. Provider business mailing address

20932 BROOKHURST ST SUITE 101
HUNTINGTON BEACH CA
92646-6638
US

V. Phone/Fax

Practice location:
  • Phone: 714-963-4559
  • Fax: 714-963-0631
Mailing address:
  • Phone: 714-963-4559
  • Fax: 714-963-0631

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: MS. ADELLE MARTINEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 714-963-4559