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Organization
FAMILY HEALTH CENTRE MEDICAL GROUP
Active
Organization
FAMILY HEALTH CENTRE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VASUKI SUE SITTAMPALAM M.D. (OWNER)
(760) 872-4311
Entity
Organization
Contact information
Practice address
686 W LINE ST, BISHOP, CA 93514-3315
(760) 872-4311
(760) 872-4130
Mailing address
686 W LINE ST, BISHOP, CA 93514-3315
(760) 872-4311
(760) 872-4130
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
C371720
CA
207R00000X
Internal Medicine Physician
Primary
A93866
CA
363L00000X
Nurse Practitioner
Y201575
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002086560
—
CA
01
—
0205422
ST OF WA DEPT LABOR INDUS
CA
01
—
183283900
OWCP
CA
05
—
GR0021672
—
CA
05
—
RHM53941F
—
CA
Enumeration date
05/12/2006
Last updated
04/28/2011
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