Healthcare Provider Details

I. General information

NPI: 1942577937
Provider Name (Legal Business Name): PRESBYTERIAN HEALTH PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W BASTANCHURY SUITE 140
FULLERTON CA
92835-3427
US

IV. Provider business mailing address

PO BOX 1277
WHITTIER CA
90609-1277
US

V. Phone/Fax

Practice location:
  • Phone: 562-694-2500
  • Fax: 562-694-2577
Mailing address:
  • Phone: 562-789-5401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number83764
License Number StateCA

VIII. Authorized Official

Name: KIMBERLY DILLARD-BETHEL
Title or Position: DIRECTOR OF BUSINESS SERVICES
Credential:
Phone: 562-789-5401