Provider Demographics
NPI:1013314046
Name:FAMILY HEALTHCARE OF CHOWCHILLA
Entity Type:Organization
Organization Name:FAMILY HEALTHCARE OF CHOWCHILLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYCIAN
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:R
Authorized Official - Last Name:FEBRES-ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-827-4747
Mailing Address - Street 1:1045 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-4204
Mailing Address - Country:US
Mailing Address - Phone:209-827-4747
Mailing Address - Fax:209-827-5831
Practice Address - Street 1:1300 ROBERTSON BLVD
Practice Address - Street 2:
Practice Address - City:CHOWCHILLA
Practice Address - State:CA
Practice Address - Zip Code:93610-2633
Practice Address - Country:US
Practice Address - Phone:209-827-4747
Practice Address - Fax:209-827-5831
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY HEALTH MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-19
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29593261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health