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General NPI Number Information
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NPI Number | 1578520144
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Entity Type | Organization
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Legal Business Name | MED ONE FAMILY MEDICAL GROUP
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 8970 WARNER AVE
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708
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Country | US
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Telephone | 714-848-7757
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Fax | 714-848-7760
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Provider Business Mailing Address
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Address Line | 8970 WARNER AVE
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708
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Country | US
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Telephone | 714-848-7757
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Fax | 714-848-7760
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | AFDAL IBRAHIM ALLAM
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Credential | MD
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Telephone | 714-848-7757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A41057
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License Number State | CA
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