Provider Demographics
NPI:1467418038
Name:FRIENDLY MEDICAL CENTER
Entity Type:Organization
Organization Name:FRIENDLY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GURPAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:PHAGUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-949-7000
Mailing Address - Street 1:15462 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-3318
Mailing Address - Country:US
Mailing Address - Phone:760-949-7000
Mailing Address - Fax:760-949-3123
Practice Address - Street 1:15462 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-3318
Practice Address - Country:US
Practice Address - Phone:760-949-7000
Practice Address - Fax:760-949-3123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 261QU0200X
CAG71819207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G71819OtherLICENSE NUMBER
CAGR0054500Medicaid
CAZZZ35061ZMedicare ID - Type Unspecified
G71819OtherLICENSE NUMBER