Provider Demographics
NPI:1982606299
Name:PREFERRED FAMILY CARE PHYSICIANS MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PREFERRED FAMILY CARE PHYSICIANS MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-638-2273
Mailing Address - Street 1:5925 TRUXTUN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0433
Mailing Address - Country:US
Mailing Address - Phone:661-638-2273
Mailing Address - Fax:661-638-2288
Practice Address - Street 1:5925 TRUXTUN AVE STE A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0433
Practice Address - Country:US
Practice Address - Phone:661-638-2273
Practice Address - Fax:661-638-2288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0915489OtherCLIA
CAGR0070260Medicaid
CAZZZ01220ZMedicare ID - Type Unspecified
CACEO906Medicare PIN