Healthcare Provider Details

I. General information

NPI: 1548087463
Provider Name (Legal Business Name): FAMILY PLANNING ASSOCIATES MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 W BENJAMIN HOLT DR STE D6
STOCKTON CA
95207-2766
US

IV. Provider business mailing address

PO BOX 10818
SAN BERNARDINO CA
92423-0818
US

V. Phone/Fax

Practice location:
  • Phone: 909-723-1044
  • Fax:
Mailing address:
  • Phone: 909-382-0201
  • Fax: 909-495-1367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. IRVING M. FELDKAMP IV IV
Title or Position: OWNER
Credential: MD
Phone: 909-382-0201