| California Functional Internal Medicine Clinic Llc | |
|
22972 El Toro Rd Lake Forest CA 92630-4961 | |
| (816) 585-4373 | |
| Not Available |
| Full Name | California Functional Internal Medicine Clinic Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 22972 El Toro Rd, Lake Forest, California |
| Authorized Official Name and Position | Mohammed W Ansari (MANAGING MEMBER) |
| Authorized Official Contact | 8165854373 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| California Functional Internal Medicine Clinic Llc 22972 El Toro Rd Lake Forest CA 92630-4961 Ph: () - | California Functional Internal Medicine Clinic Llc 22972 El Toro Rd Lake Forest CA 92630-4961 Ph: (816) 585-4373 |
| NPI Number | 1609633049 |
|---|---|
| Provider Enumeration Date | 03/04/2024 |
| Last Update Date | 03/04/2024 |
| Medicare PECOS PAC ID | 8628415411 |
|---|---|
| Medicare Enrollment ID | O20240328003096 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609633049 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Mohammed Waseem Uddin Ansari |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1952744948 PECOS PAC ID: 9335431683 Enrollment ID: I20240328003170 |
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California Functional Internal Medicine Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 22972 El Toro Rd, Lake Forest, CA 92630 Phone: 949-339-5272 |