1255470167 NPI number — FAMILY PLANNING ASSOCIATES MEDICAL GROUP INC

Table of content: (NPI 1255470167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255470167 NPI number — FAMILY PLANNING ASSOCIATES MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY PLANNING ASSOCIATES MEDICAL GROUP INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255470167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10818
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN BERNARDINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92423-0818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-382-0201
Provider Business Mailing Address Fax Number:
909-495-1321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1060 N 13TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91786-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-626-2463
Provider Business Practice Location Address Fax Number:
909-494-7812
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FELDKAMP IV
Authorized Official First Name:
IRVING
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
909-382-0201

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05D0668294 . This is a "CLIA ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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