MEDICARE: FAMILY PRIMARY AND SPECIALTY CARE CLINIC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1871487199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PRIMARY AND SPECIALTY CARE CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 16297
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90209-2297
Country	:	US
Telephone Number	:	661-425-0295
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 W AVENUE K STE 200
Second Line	:
City	:	LANCASTER
State	:	CA
Zip	:	93534-5925
Country	:	US
Telephone Number	:	661-425-0295
Fax Number	:

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. ROBERTO SANTANA
Credential	:
Telephone Number	:	661-425-0295

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	02/03/2026

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