Provider Demographics
NPI:1740757996
Name:FAMILY MEDICINE HEADQUARTERS, INC
Entity Type:Organization
Organization Name:FAMILY MEDICINE HEADQUARTERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARIAR
Authorized Official - Middle Name:
Authorized Official - Last Name:BORBOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-873-7527
Mailing Address - Street 1:1014 BROADWAY # 617
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2808
Mailing Address - Country:US
Mailing Address - Phone:310-873-7527
Mailing Address - Fax:
Practice Address - Street 1:521 N AZUSA AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2936
Practice Address - Country:US
Practice Address - Phone:626-334-4061
Practice Address - Fax:626-334-6828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty