| Moulton Family Medical, Inc. | |
|
22611 Lake Forest Dr. #c-4 Lake Forest CA 92630 | |
| (949) 951-9399 | |
| (949) 951-9403 |
| Full Name | Moulton Family Medical, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 22611 Lake Forest Dr. #c-4, Lake Forest, California |
| Authorized Official Name and Position | Nelly Boutros (OWNER) |
| Authorized Official Contact | 9499519399 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moulton Family Medical, Inc. Po Box 8095 Fountain Valley CA 92728-8095 Ph: (949) 951-9399 | Moulton Family Medical, Inc. 22611 Lake Forest Dr. #c-4 Lake Forest CA 92630 Ph: (949) 951-9399 |
| NPI Number | 1538190954 |
|---|---|
| Provider Enumeration Date | 07/05/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538190954 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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