Healthcare Provider Details

I. General information

NPI: 1275576522
Provider Name (Legal Business Name): GN MEDICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 BRISTOL ST STE 200
COSTA MESA CA
92626-3061
US

IV. Provider business mailing address

3090 BRISTOL ST STE 200
COSTA MESA CA
92626-3061
US

V. Phone/Fax

Practice location:
  • Phone: 888-789-9585
  • Fax: 562-803-4500
Mailing address:
  • Phone: 888-789-9585
  • Fax: 714-619-3069

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 Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTINE MLOT
Title or Position: PRESIDENT
Credential: MD
Phone: 888-798-9585