MEDICARE: MY WAY MANAGEMENT SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G78673	CA

General Provider Information

NPI Number	:	1447283437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY WAY MANAGEMENT SERVICES, LLC

Provider Business Mailing Address
First Line	:	2913 EL CAMINO REAL # 344
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-8909
Country	:	US
Telephone Number	:	714-296-6377
Fax Number	:

Provider Business Practice Location Address
First Line	:	2913 EL CAMINO REAL # 344
Second Line	:
City	:	TUSTIN
State	:	CA
Zip	:	92782-8909
Country	:	US
Telephone Number	:	714-296-6377
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PHYLLIS KAYE BRUNDIDGE
Credential	:	M.D.
Telephone Number	:	714-296-6377

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	08/22/2020

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Directions to “MY WAY MANAGEMENT SERVICES, LLC ” Practice Location

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