Healthcare Provider Details

I. General information

NPI: 1417208141
Provider Name (Legal Business Name): NEW GENESIS MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N EUCLID ST STE 203
ANAHEIM CA
92801-4122
US

IV. Provider business mailing address

710 N EUCLID ST # 400
ANAHEIM CA
92801-4122
US

V. Phone/Fax

Practice location:
  • Phone: 714-551-9720
  • Fax: 714-560-7678
Mailing address:
  • Phone: 714-517-2000
  • Fax: 714-300-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. MITCHELL LEW
Title or Position: OWNER
Credential: MD
Phone: 714-813-5129