Healthcare Provider Details

I. General information

NPI: 1306149091
Provider Name (Legal Business Name): QUALITY CARE IPA A MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 12/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 S BROOKHURST ST 201
ANAHEIM CA
92804-3510
US

IV. Provider business mailing address

631 S BROOKHURST ST 201
ANAHEIM CA
92804-3510
US

V. Phone/Fax

Practice location:
  • Phone: 714-739-5959
  • Fax: 714-739-5974
Mailing address:
  • Phone: 714-739-5959
  • Fax: 714-739-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: JAMAL A ANAIM
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-739-5959