Provider Demographics
NPI:1790306074
Name:FHMC GROUP INC
Entity Type:Organization
Organization Name:FHMC GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:CORRALES
Authorized Official - Last Name:BANEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-221-3103
Mailing Address - Street 1:9043 WOODMAN AVE STE C
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6493
Mailing Address - Country:US
Mailing Address - Phone:818-221-3096
Mailing Address - Fax:818-221-3098
Practice Address - Street 1:9043 WOODMAN AVE STE C
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-6493
Practice Address - Country:US
Practice Address - Phone:818-221-3096
Practice Address - Fax:818-221-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care