Healthcare Provider Details

I. General information

NPI: 1619958527
Provider Name (Legal Business Name): MICHAEL F OZAKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11420 WARNER AVE
FOUNTAIN VALLEY CA
92708-2529
US

IV. Provider business mailing address

2742 DOW AVE
TUSTIN CA
92780-7242
US

V. Phone/Fax

Practice location:
  • Phone: 714-549-1300
  • Fax: 714-433-3100
Mailing address:
  • Phone: 714-665-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA42136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: