Healthcare Provider Details

I. General information

NPI: 1750614616
Provider Name (Legal Business Name): ARTHUR AZCONA D.C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2009
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2675 IRVINE AVE SUIT E
COSTA MESA CA
92627-4653
US

IV. Provider business mailing address

PO BOX 6612
HUNTINGTON BEACH CA
92615-6612
US

V. Phone/Fax

Practice location:
  • Phone: 714-910-1478
  • Fax: 714-849-6584
Mailing address:
  • Phone: 714-910-1478
  • Fax: 714-849-6584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number31385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: