MEDICARE: FIRST CARE 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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1831612910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CARE MEDICAL GROUP INC.

Provider Business Mailing Address
First Line	:	1655 N MOUNT VERNON AVE STE B1
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411-1427
Country	:	US
Telephone Number	:	626-497-0611
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 N MOUNT VERNON AVE STE B1
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92411-1427
Country	:	US
Telephone Number	:	626-497-0611
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JOHN MALEK
Credential	:
Telephone Number	:	909-586-6260

Provider Enumeration Date	:	07/20/2017
Last Update Date	:	07/21/2022

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