Healthcare Provider Details

I. General information

NPI: 1053408278
Provider Name (Legal Business Name): PRIMARY AND MULTI SPECIALTY CLINICS OF ANAHEIM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2006
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N EUCLID ST STE 101
ANAHEIM CA
92801-4132
US

IV. Provider business mailing address

710 N EUCLID ST STE 400
ANAHEIM CA
92801-4132
US

V. Phone/Fax

Practice location:
  • Phone: 714-517-2000
  • Fax: 714-490-1975
Mailing address:
  • Phone: 714-517-2000
  • Fax: 714-490-1975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JEROD ELLIOTT
Title or Position: DIRECTOR
Credential:
Phone: 562-537-2814