| Traditional Family Practice Inc | |
|
2204 Torrance Blvd Suite 105 Torrance CA 90501-2544 | |
| (310) 328-2146 | |
| (310) 328-2242 |
| Full Name | Traditional Family Practice Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2204 Torrance Blvd, Torrance, California |
| Authorized Official Name and Position | Ludmila Afonicheva (CEO) |
| Authorized Official Contact | 3103282146 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Traditional Family Practice Inc 2204 Torrance Blvd Suite 105 Torrance CA 90501-2544 Ph: (310) 328-2146 | Traditional Family Practice Inc 2204 Torrance Blvd Suite 105 Torrance CA 90501-2544 Ph: (310) 328-2146 |
| NPI Number | 1053507822 |
|---|---|
| Provider Enumeration Date | 09/14/2007 |
| Last Update Date | 06/17/2013 |
| Medicare PECOS PAC ID | 4981670635 |
|---|---|
| Medicare Enrollment ID | O20040903000857 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053507822 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | W17913 (California) | Primary |
| Provider Name | Ludmila W Afonicheva |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932159530 PECOS PAC ID: 9830182922 Enrollment ID: I20040405001596 |
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