Healthcare Provider Details

I. General information

NPI: 1942255195
Provider Name (Legal Business Name): FAMILY CARE SPECIALISTS MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E CESAR CHAVEZ AVENUE SUITE 230
LOS ANGELES CA
90033-2464
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 323-226-1100
  • Fax: 323-226-1101
Mailing address:
  • Phone: 323-255-5643
  • Fax: 323-255-2158

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: MAURICIO EDUARDO BUENO
Title or Position: MEDICAL GROUP DIRECTOR
Credential:
Phone: 323-317-9200