1598763369 NPI number — SPORTS MEDICINE INSTITUTE SOUTH ORANGE COUNTY

Table of content: MISS ARIEL FIPPS MD (NPI 1215721923)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598763369 NPI number — SPORTS MEDICINE INSTITUTE SOUTH ORANGE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPORTS MEDICINE INSTITUTE SOUTH ORANGE COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598763369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1070 N BATAVIA ST
Provider Second Line Business Mailing Address:
#537
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92867-5598
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-493-1985
Provider Business Mailing Address Fax Number:
949-493-4295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27184 ORTEGA HWY
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
SAN JUAN CAPISTRANO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92675-5705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-493-1985
Provider Business Practice Location Address Fax Number:
949-493-4295
Provider Enumeration Date:
07/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BOESEL
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
714-939-6200

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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