Healthcare Provider Details

I. General information

NPI: 1295782423
Provider Name (Legal Business Name): YORBA LINDA FAMILY PHYSICIANS, A MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 04/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 YORBA LINDA BLVD SUITE 201
YORBA LINDA CA
92886-4052
US

IV. Provider business mailing address

18200 YORBA LINDA BLVD SUITE 401
YORBA LINDA CA
92886-4056
US

V. Phone/Fax

Practice location:
  • Phone: 714-577-6000
  • Fax: 714-572-2562
Mailing address:
  • Phone: 714-646-8000
  • Fax: 714-572-2562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name: THOMAS BARKER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-646-8000