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General NPI Number Information
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NPI Number | 1356532147
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Entity Type | Organization
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Legal Business Name | FAMILY CARE MEDICAL CENTER
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 1205 N JOSEY LN
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City | CARROLLTON
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State | TX
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Zip | 75006-6145
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Country | US
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Telephone | 972-242-2726
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Fax | 972-242-5266
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Provider Business Mailing Address
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Address Line | 1205 N JOSEY LN
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City | CARROLLTON
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State | TX
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Zip | 75006-6145
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Country | US
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Telephone | 972-242-2726
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Fax | 972-242-5266
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | GUILLERMO M FUENTES
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Credential | DO
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Telephone | 972-242-2726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | K8749
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License Number State | TX
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