Healthcare Provider Details

I. General information

NPI: 1457433542
Provider Name (Legal Business Name): ALISON METHERELL MANN M.D., M.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ALISON KAREN METHERELL

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 W. BAKER STREET STE 103
COSTA MESA CA
92626
US

IV. Provider business mailing address

PO BOX 1813
SUISUN CITY CA
94585-4813
US

V. Phone/Fax

Practice location:
  • Phone: 714-668-2525
  • Fax: 714-668-2530
Mailing address:
  • Phone: 657-241-3600
  • Fax: 657-241-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA73789
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA73789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: