Provider Demographics
NPI:1013430982
Name:FAMILY WELLNESS CLINIC, INC
Entity Type:Organization
Organization Name:FAMILY WELLNESS CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-360-9698
Mailing Address - Street 1:1817 SHAW AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4069
Mailing Address - Country:US
Mailing Address - Phone:559-940-6664
Mailing Address - Fax:
Practice Address - Street 1:1817 SHAW AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-4069
Practice Address - Country:US
Practice Address - Phone:559-360-9698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty