Provider Demographics
NPI:1740233725
Name:FCS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:FCS MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:RAMON
Authorized Official - Last Name:SAMANIEGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-255-5643
Mailing Address - Street 1:5823 YORK BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-2634
Mailing Address - Country:US
Mailing Address - Phone:323-255-5643
Mailing Address - Fax:323-254-2158
Practice Address - Street 1:815 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-6123
Practice Address - Country:US
Practice Address - Phone:323-728-3955
Practice Address - Fax:323-728-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACQ2165OtherRAILROAD MEDICARE GROUP
CAZZZ22101ZOtherBLUE SHIELD GROUP ID
CAW10759AOtherMEDICARE GROUP ID
CAGR0040672OtherMEDICAID GROUP ID