=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497167696
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HUNTINGTON BEACH FAMILY MEDICINE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2014
-----------------------------------------------------
Last Update Date | 10/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19400 BEACH BLVD #11
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92648-2500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-968-1222
-----------------------------------------------------
Fax | 714-968-1777
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19400 BEACH BLVD #11
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92648-2500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-968-1222
-----------------------------------------------------
Fax | 714-968-1777
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NATASHA G THOMAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 714-968-1222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | A115473
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------