Healthcare Provider Details

I. General information

NPI: 1710444096
Provider Name (Legal Business Name): ALISON METHERELL, MD, MPH, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 W. BAKER STREET STE 103
COSTA MESA CA
92626-4105
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 TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALISON M MANN
Title or Position: OWNER
Credential: MD
Phone: 310-770-2521