Fma Family Practice Inc
Organization Active NPI Family Medicine Physician · Moorpark, CA
NPI 1114308343 · NPPES record last updated Sep 22, 2015
Key facts
- NPI
- 1114308343
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 20A11553 (CA)
- Legal business name
- FMA FAMILY PRACTICE INC
- Practice address
- 885 Patriot Dr
Unit F
Moorpark, CA 93021-3361 - Phone
- (805) 334-1371
- NPI assigned
- Jun 12, 2015
- Organization subpart
- No
Authorized official
- Name
- Dr. Fadel Abdulhai, D.O.
- Title
- Physician
- Phone
- (310) 738-4975
Practitioners 1
-
Fadel Abdulhai, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2103862 | Patriot Family Medicine | Certificate of waiver | Oct 20, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20151019001767 | CA | Part B Supplier - Clinic/Group Practice | 5496064230 |
Receives reassigned benefits from 1 practitioner Practice locations: Moorpark, CA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 20A11553 | CA | Yes |
Addresses
Primary practice location
885 Patriot Dr
Unit F
Moorpark, CA 93021-3361
Mailing address
885 Patriot Dr
Unit F
Moorpark, CA 93021-3361
Phone (805) 334-1371
Other names
- Patriot Family Medicine
Other providers in Moorpark, CA
- John A Farag
- Katrina Fernandes
- Fischer Medical Supply Inc
- Cassandra Fisher
- Rio Ann Fitzgerald
- Fora Care Inc.
- Brian Robert Forcey
- Amanda B Ford
- Mirette Girgis Fouad
- Jessica Garcia
All providers in Moorpark, CA · Family Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 22, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.