1770858441 NPI number — MISSION INTERNAL MEDICAL FROUP, INC.

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 1770858441 NPI number — MISSION INTERNAL MEDICAL FROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSION INTERNAL MEDICAL FROUP, INC.
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:
1770858441
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26522 LA ALAMEDA
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92691-6330
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-282-1671
Provider Business Mailing Address Fax Number:
949-367-0518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26800 CROWN VALLEY PKWY
Provider Second Line Business Practice Location Address:
SUITE 275
Provider Business Practice Location Address City Name:
MISSION VIEJO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92691-6384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-542-8002
Provider Business Practice Location Address Fax Number:
949-542-7337
Provider Enumeration Date:
03/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FELCE
Authorized Official First Name:
MARCIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
949-282-1671

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  579745 , 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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