Healthcare Provider Details

I. General information

NPI: 1427446012
Provider Name (Legal Business Name): CALIFORNIA CENTER FOR PELVIC FLOOR DISORDERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 09/14/2023
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E COAST HWY STE 200
CORONA DEL MAR CA
92625-1934
US

IV. Provider business mailing address

2121 E COAST HWY STE 200
CORONA DEL MAR CA
92625-1934
US

V. Phone/Fax

Practice location:
  • Phone: 949-797-7993
  • Fax:
Mailing address:
  • Phone: 949-797-7993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088F0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Urology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICKEY M KARRAM
Title or Position: PRESIDENT
Credential: MD
Phone: 949-793-7993