California Functional Internal Medicine Inc | |
22972 El Toro Rd Lake Forest CA 92630-4961 | |
(949) 339-5272 | |
Not Available |
Full Name | California Functional Internal Medicine Inc |
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Speciality | Internal Medicine |
Location | 22972 El Toro Rd, Lake Forest, California |
Authorized Official Name and Position | Mohammed W Ansari (OWNER) |
Authorized Official Contact | 8165854373 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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California Functional Internal Medicine Inc 40 Winterhaven Irvine CA 92614-7914 Ph: (816) 585-4373 | California Functional Internal Medicine Inc 22972 El Toro Rd Lake Forest CA 92630-4961 Ph: (949) 339-5272 |
NPI Number | 1356101067 |
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Provider Enumeration Date | 03/20/2024 |
Last Update Date | 03/20/2024 |
Medicare PECOS PAC ID | 2769821578 |
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Medicare Enrollment ID | O20240412002203 |
Identifier | Type | State | Issuer |
---|---|---|---|
1356101067 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (* (Not Available)) | Primary |
Provider Name | Mohammed Waseem Uddin Ansari |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1952744948 PECOS PAC ID: 9335431683 Enrollment ID: I20240328003170 |
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