Provider Demographics
NPI:1043603657
Name:MY FAMILY CLINIC, INC.
Entity Type:Organization
Organization Name:MY FAMILY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-625-9870
Mailing Address - Street 1:43781 CULEBRA LN
Mailing Address - Street 2:
Mailing Address - City:BERMUDA DUNES
Mailing Address - State:CA
Mailing Address - Zip Code:92203-1523
Mailing Address - Country:US
Mailing Address - Phone:760-799-4957
Mailing Address - Fax:760-200-2870
Practice Address - Street 1:81709 DR CARREON BLVD STE C5
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5577
Practice Address - Country:US
Practice Address - Phone:760-799-4957
Practice Address - Fax:760-200-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-07
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77736261QP2300X
CARN500867261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care