Healthcare Provider Details

I. General information

NPI: 1043631575
Provider Name (Legal Business Name): FCS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2013
Last Update Date: 12/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 S GRAND AVE SUITE 401
LOS ANGELES CA
90015-3070
US

IV. Provider business mailing address

5823 YORK BLVD SUITE 3
LOS ANGELES CA
90042-2634
US

V. Phone/Fax

Practice location:
  • Phone: 213-742-6400
  • Fax:
Mailing address:
  • Phone: 323-255-5643
  • Fax: 323-254-2158

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: DR. EDWARD CASTRO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 323-255-5643