Healthcare Provider Details

I. General information

NPI: 1962833319
Provider Name (Legal Business Name): FIRST CHOICE PHYSICIAN PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2013
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1079 EUCALYPTUS ST SUITE #A
MANTECA CA
95337-4317
US

IV. Provider business mailing address

1079 EUCALYPTUS ST SUITE #A
MANTECA CA
95337-4317
US

V. Phone/Fax

Practice location:
  • Phone: 209-239-6008
  • Fax: 209-239-3408
Mailing address:
  • Phone: 209-239-6008
  • Fax: 209-239-3408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFF KOUREY
Title or Position: CEO
Credential:
Phone: 714-428-6842