Provider Demographics
NPI:1730372038
Name:ADVANCED FAMILY CARE MEDICAL GROUP INC
Entity type:Organization
Organization Name:ADVANCED FAMILY CARE MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ABDOULAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-588-0084
Mailing Address - Street 1:2704 W MANCHESTER BLVD
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-2436
Mailing Address - Country:US
Mailing Address - Phone:323-778-4310
Mailing Address - Fax:
Practice Address - Street 1:2704 W MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-2436
Practice Address - Country:US
Practice Address - Phone:323-778-4310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANMW1068261QM1300X
CAG42217261QP2300X
CAPA12322261QP2300X
CAA33986261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0077510Medicaid