Provider Demographics
NPI:1215376496
Name:FIRST CHOICE PHYSICIAN PARTNERS
Entity Type:Organization
Organization Name:FIRST CHOICE PHYSICIAN PARTNERS
Other - Org Name:VENTANA HEALTH AND MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP REGIONAL OPERATIONS; TENET
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:KOURY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-428-6842
Mailing Address - Street 1:PO BOX 748263
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-8063
Mailing Address - Country:US
Mailing Address - Phone:805-489-2205
Mailing Address - Fax:
Practice Address - Street 1:901 OAK PARK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3408
Practice Address - Country:US
Practice Address - Phone:805-489-2205
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST CHOICE PHYSICIAN PARTNERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-20
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty