Provider Demographics
NPI:1205024718
Name:FAMILY MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:FAMILY MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANUTA
Authorized Official - Middle Name:U
Authorized Official - Last Name:DELNITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-240-8555
Mailing Address - Street 1:34052 LA PLZ
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-2587
Mailing Address - Country:US
Mailing Address - Phone:949-240-8555
Mailing Address - Fax:
Practice Address - Street 1:34052 LA PLZ
Practice Address - Street 2:SUITE 102
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-2587
Practice Address - Country:US
Practice Address - Phone:949-240-8555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17912Medicare PIN