Provider Demographics
NPI:1689066029
Name:FAMILY FIRST MEDICAL CARE A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:FAMILY FIRST MEDICAL CARE A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SILVIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-869-5678
Mailing Address - Street 1:1317 OAKDALE RD
Mailing Address - Street 2:SUITE 440
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3361
Mailing Address - Country:US
Mailing Address - Phone:209-869-5678
Mailing Address - Fax:209-869-6357
Practice Address - Street 1:2603 PATTERSON RD
Practice Address - Street 2:SUITE 1
Practice Address - City:RIVERBANK
Practice Address - State:CA
Practice Address - Zip Code:95367-3407
Practice Address - Country:US
Practice Address - Phone:209-869-5678
Practice Address - Fax:209-869-6357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty