Organization
AMERICAN FAMILY MEDICAL PROVIDERS INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STAN MATHIOULAKIS M.D. (PRESIDENT)
(626) 358-3204
Entity
Organization
Contact information
Practice address
931 BUENA VISTA ST STE 102, DUARTE, CA 91010-1780
(626) 358-3204
Mailing address
931 BUENA VISTA ST STE 102, DUARTE, CA 91010-1780
(626) 358-3204
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A85470
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A85470
CALIFORNIA STATE LICENSE
CA
Enumeration date
11/05/2007
Last updated
02/06/2018
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