Provider Demographics
NPI:1164448593
Name:CAL CHOICE FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:CAL CHOICE FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-955-5555
Mailing Address - Street 1:PO BOX 1596
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-1596
Mailing Address - Country:US
Mailing Address - Phone:760-955-9555
Mailing Address - Fax:760-955-8558
Practice Address - Street 1:16245 DESERT KNOLL DR
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4011
Practice Address - Country:US
Practice Address - Phone:760-955-9555
Practice Address - Fax:760-955-8558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87666261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03632ZMedicare ID - Type Unspecified