Provider Demographics
NPI:1629027255
Name:UNITED FAMILY CARE
Entity Type:Organization
Organization Name:UNITED FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-357-1595
Mailing Address - Street 1:8110 MANGO AVE
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335
Mailing Address - Country:US
Mailing Address - Phone:909-822-1164
Mailing Address - Fax:909-357-2235
Practice Address - Street 1:8110 MANGO AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335
Practice Address - Country:US
Practice Address - Phone:909-822-1164
Practice Address - Fax:909-357-2235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP7110163W00000X
CA20A6914207P00000X
CAA45447207PE0004X
CAA36223207Q00000X
CAG67483207Q00000X
CAA74033207R00000X
CAA75923207R00000X
CAA62436207R00000X
CAG80704207R00000X
CAA32826207R00000X
CAA51183207R00000X
CAA41815208000000X
CAA85338208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18222ZMedicare PIN
CAZZZ18223ZMedicare PIN
CAZZZ18224ZMedicare PIN