Provider Demographics
NPI:1972828085
Name:DURFEE FAMILY CARE MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DURFEE FAMILY CARE MEDICAL GROUP A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISHAK
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-442-5015
Mailing Address - Street 1:2006 DURFEE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-3713
Mailing Address - Country:US
Mailing Address - Phone:626-442-5015
Mailing Address - Fax:626-442-7810
Practice Address - Street 1:2006 DURFEE AVE
Practice Address - Street 2:
Practice Address - City:SOUTH EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-3713
Practice Address - Country:US
Practice Address - Phone:626-442-5015
Practice Address - Fax:626-442-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-31
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA04531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty