MEDICARE: FOOTHILL PRIMARY CARE, 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	208D00000X	General Practice Physician	G53517	CA

General Provider Information

NPI Number	:	1720350259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOOTHILL PRIMARY CARE, INC.

Provider Business Mailing Address
First Line	:	931 BUENA VISTA ST STE 205
Second Line	:
City	:	DUARTE
State	:	CA
Zip	:	91010-1713
Country	:	US
Telephone Number	:	626-358-1897
Fax Number	:	626-301-0937

Provider Business Practice Location Address
First Line	:	931 BUENA VISTA ST STE 205
Second Line	:
City	:	DUARTE
State	:	CA
Zip	:	91010-1713
Country	:	US
Telephone Number	:	626-358-1897
Fax Number	:	626-301-0937

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROY L. SAENZ
Credential	:	M.D.
Telephone Number	:	626-358-1897

Provider Enumeration Date	:	01/30/2012
Last Update Date	:	02/21/2012

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