Provider Demographics
NPI:1740796457
Name:FAMILY MEDICAL AND OCCUPATIONAL CLINIC PC
Entity Type:Organization
Organization Name:FAMILY MEDICAL AND OCCUPATIONAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:FOUAD
Authorized Official - Last Name:YOUSSEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-328-7333
Mailing Address - Street 1:1120 W LA PALMA AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2805
Mailing Address - Country:US
Mailing Address - Phone:714-774-0754
Mailing Address - Fax:714-774-0119
Practice Address - Street 1:1120 W LA PALMA AVE STE 10
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2805
Practice Address - Country:US
Practice Address - Phone:714-774-0754
Practice Address - Fax:714-774-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42255207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty