Healthcare Provider Details

I. General information

NPI: 1033267216
Provider Name (Legal Business Name): ADVANCED FAMILY CARE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E FLORENCE AVE
LOS ANGELES CA
90001-2432
US

IV. Provider business mailing address

1201 E FLORENCE AVE
LOS ANGELES CA
90001-2432
US

V. Phone/Fax

Practice location:
  • Phone: 323-588-0084
  • Fax:
Mailing address:
  • Phone: 323-588-0084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberA33986
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberNMW1068
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA88137
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberPA16806
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberG42217
License Number StateCA

VIII. Authorized Official

Name: LORNA JOHNSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 323-588-0084