Provider Demographics
NPI:1184941718
Name:ANAHEIM FAMILY CARE
Entity type:Organization
Organization Name:ANAHEIM FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-535-1415
Mailing Address - Street 1:947 S ANAHEIM BLVD STE 270
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5584
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:947 S ANAHEIM BLVD STE 270
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5584
Practice Address - Country:US
Practice Address - Phone:714-535-1415
Practice Address - Fax:714-533-0237
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANAHEIM FAMILY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-21
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty