Provider Demographics
NPI:1114308343
Name:FMA FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:FMA FAMILY PRACTICE INC
Other - Org Name:PATRIOT FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FADEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDULHAI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-738-4975
Mailing Address - Street 1:885 PATRIOT DR
Mailing Address - Street 2:UNIT F
Mailing Address - City:MOORPARK
Mailing Address - State:CA
Mailing Address - Zip Code:93021-3361
Mailing Address - Country:US
Mailing Address - Phone:805-334-1371
Mailing Address - Fax:
Practice Address - Street 1:885 PATRIOT DR
Practice Address - Street 2:UNIT F
Practice Address - City:MOORPARK
Practice Address - State:CA
Practice Address - Zip Code:93021-3361
Practice Address - Country:US
Practice Address - Phone:805-334-1371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-12
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11553207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty