Provider Demographics
NPI:1477677961
Name:FAMILY CARE SPECIALISTS IPA
Entity Type:Organization
Organization Name:FAMILY CARE SPECIALISTS IPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-971-6717
Mailing Address - Street 1:955 OVERLAND CT FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-1718
Mailing Address - Country:US
Mailing Address - Phone:909-971-6717
Mailing Address - Fax:909-971-6767
Practice Address - Street 1:955 OVERLAND CT FL 2
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1718
Practice Address - Country:US
Practice Address - Phone:909-971-6717
Practice Address - Fax:909-971-6767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty