Organization · NPI-2

101 Family Medical Group,a Professional Corp

Clinic/Center, Primary Care · Canoga Park, CA

NPI number1174856348
StatusActive
Last updated in NPPESApr 7, 2011

Details

NPI
1174856348
Entity type
Organization (NPI-2)
Legal business name
101 Family Medical Group,a Professional Corp
Organization subpart
No
Enumeration date
Sep 6, 2009
Last updated
Apr 7, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QP2300X Clinic/Center, Primary CareA85704CAYes

Practice location

22030 Sherman Way Ste 101
Canoga Park, CA 91303-1844

Phone 818-312-9101 · Fax 818-312-9100

Mailing address

7201 Rockridge Ter
West Hills, CA 91307-1265

Phone 818-312-9101 · Fax 818-312-9100

Authorized official

Hessam Aazami
Medical Director
8183129101

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