Healthcare Provider Details

I. General information

NPI: 1235006172
Provider Name (Legal Business Name): CAS HEALTH MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3090 BRISTOL ST
COSTA MESA CA
92626-3079
US

IV. Provider business mailing address

3090 BRISTOL ST
COSTA MESA CA
92626-3079
US

V. Phone/Fax

Practice location:
  • Phone: 909-982-2088
  • Fax:
Mailing address:
  • Phone: 909-982-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: WARREN GABRILLO
Title or Position: MANAGER
Credential: MD
Phone: 909-982-2088