MEDICARE: FAMILY PRACTICE ASSOCIATES OF CARSON MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G74550	CA

General Provider Information

NPI Number	:	1316996903
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRACTICE ASSOCIATES OF CARSON MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	824 E CARSON ST
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90745-2262
Country	:	US
Telephone Number	:	310-233-3228
Fax Number	:	310-233-3229

Provider Business Practice Location Address
First Line	:	824 E CARSON ST
Second Line	:	SUITE 201
City	:	CARSON
State	:	CA
Zip	:	90745-2262
Country	:	US
Telephone Number	:	310-233-3228
Fax Number	:	310-233-3229

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. REZA GHANIAN
Credential	:	MD
Telephone Number	:	310-233-3228

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	04/24/2014

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