Healthcare Provider Details

I. General information

NPI: 1578421046
Provider Name (Legal Business Name): E. TRACY M.D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19671 BEACH BLVD STE 201
HUNTINGTON BEACH CA
92648-5903
US

IV. Provider business mailing address

19671 BEACH BLVD STE 201
HUNTINGTON BEACH CA
92648-5903
US

V. Phone/Fax

Practice location:
  • Phone: 714-740-7597
  • Fax: 714-740-7672
Mailing address:
  • Phone: 714-740-7597
  • Fax: 714-740-7672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH TRACY
Title or Position: PRESIDENT, OWNER
Credential: MD
Phone: 714-740-7597