Provider Demographics
NPI:1316623200
Name:OUR LADY OF FATIMA FAMILY AND WELL CARE CLINIC
Entity type:Organization
Organization Name:OUR LADY OF FATIMA FAMILY AND WELL CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:ANALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMOJERA- DE LEUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-588-6240
Mailing Address - Street 1:532 N HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:213-714-5886
Mailing Address - Fax:
Practice Address - Street 1:7002 MOODY ST STE 108
Practice Address - Street 2:
Practice Address - City:LA PALMA
Practice Address - State:CA
Practice Address - Zip Code:90623
Practice Address - Country:US
Practice Address - Phone:714-588-6240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty