Provider Demographics
NPI:1497951370
Name:CENTRO MEDICO FAMILIAR
Entity Type:Organization
Organization Name:CENTRO MEDICO FAMILIAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-997-3232
Mailing Address - Street 1:14547 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-1619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14547 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1619
Practice Address - Country:US
Practice Address - Phone:818-997-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45553Medicare PIN
CAE20159Medicare UPIN