1831108901 NPI number — PRIVATE HOSPITALIST MEDICAL GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831108901 NPI number — PRIVATE HOSPITALIST MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIVATE HOSPITALIST MEDICAL GROUP
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:
1831108901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26671 ALISO CREEK RD
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
ALISO VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92656-4809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-831-0339
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26671 ALISO CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
ALISO VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92656-4809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-831-0339
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JAMALI
Authorized Official First Name:
MEHRNAZ
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
949-831-0300

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  30845 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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