MEDICARE: FAMILY CARE MEDICAL ASS

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	G47665	CA
2	2083X0100X	Occupational Medicine Physician	G47665	CA

General Provider Information

NPI Number	:	1962540682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE MEDICAL ASS

Provider Business Mailing Address
First Line	:	18582 BEACH BLVD STE 23A
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2012
Country	:	US
Telephone Number	:	714-964-4448
Fax Number	:	714-963-3780

Provider Business Practice Location Address
First Line	:	18582 BEACH BLVD STE 23A
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2012
Country	:	US
Telephone Number	:	714-964-4448
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MS. BILJANA SREDANOVIC
Credential	:	BA, MBA
Telephone Number	:	714-964-4448

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	04/30/2008

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Directions to “FAMILY CARE MEDICAL ASS ” Practice Location

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