Basic Information
| Provider Information | |||||||||
| NPI: | 1598067167 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTERS FOR FAMILY MEDICINE | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3460 KATELLA AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ALAMITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907202334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625946599 | ||||||||
| FaxNumber: | 5624934771 | ||||||||
| Practice Location | |||||||||
| Address1: | 3460 KATELLA AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ALAMITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907202334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5625946599 | ||||||||
| FaxNumber: | 5624934771 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2010 | ||||||||
| LastUpdateDate: | 12/06/2010 | ||||||||
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| AuthorizedOfficialLastName: | CENICEROS | ||||||||
| AuthorizedOfficialFirstName: | JEANNE | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING & COLLECTIONS MGR | ||||||||
| AuthorizedOfficialTelephone: | 5625946599 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302F00000X | Y | Managed Care Organizations | Exclusive Provider Organization |
No ID Information.