Healthcare Provider Details

I. General information

NPI: 1184759854
Provider Name (Legal Business Name): FAMILY SENIORS MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 AIRPORT PLAZA DR SUITE 150
LONG BEACH CA
90815-1271
US

IV. Provider business mailing address

5000 AIRPORT PLAZA DR SUITE 150
LONG BEACH CA
90815-1271
US

V. Phone/Fax

Practice location:
  • Phone: 562-766-2000
  • Fax: 562-766-2006
Mailing address:
  • Phone: 562-766-2000
  • Fax: 562-766-2006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number1876760
License Number StateCA

VIII. Authorized Official

Name: DR. LARRY C. HUGHES
Title or Position: PRESIDENT
Credential: M.D.
Phone: 562-766-2000