Provider Demographics
NPI:1902089808
Name:IRVINE FAMILY PRACTICE MEDICAL
Entity type:Organization
Organization Name:IRVINE FAMILY PRACTICE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-552-4584
Mailing Address - Street 1:14150 CULVER DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604
Mailing Address - Country:US
Mailing Address - Phone:949-552-4584
Mailing Address - Fax:949-551-5612
Practice Address - Street 1:14150 CULVER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0315
Practice Address - Country:US
Practice Address - Phone:949-552-4584
Practice Address - Fax:949-551-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty