Full Care Medical Group, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

48607 Issued in CA

Legal business name

FULL CARE MEDICAL GROUP, INC.

Practice address

3903 Lone Tree Way
Suite 104
Antioch, CA 94509-6249

Phone

(925) 755-1255

Fax

(925) 755-1259

NPI assigned

Jul 8, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Terri A Khonsari

Title

Cfo Business Manager

Phone

(925) 755-1255

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355875200000",
    "number": "1215960091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3903 LONE TREE WAY",
            "address_2": "SUITE 104",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945096249",
            "telephone_number": "925-755-1255",
            "fax_number": "925-755-1259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 LONE TREE WAY",
            "address_2": "SUITE 104",
            "city": "ANTIOCH",
            "state": "CA",
            "postal_code": "945096249",
            "telephone_number": "925-755-1255",
            "fax_number": "925-755-1259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL CARE MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2012-12-19",
        "status": "A",
        "authorized_official_last_name": "KHONSARI",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CFO  BUSINESS MANAGER",
        "authorized_official_telephone_number": "925-755-1255"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "48607",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Antioch, CA
• Providers in Antioch, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.