Healthcare Provider Details

I. General information

NPI: 1538649330
Provider Name (Legal Business Name): INFUSION MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17822 BEACH BLVD STE 373
HUNTINGTON BEACH CA
92647-7115
US

IV. Provider business mailing address

3943 IRVINE BLVD STE 628
IRVINE CA
92602-2400
US

V. Phone/Fax

Practice location:
  • Phone: 714-274-9536
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. NICOLE DILMORE
Title or Position: OPERATIONS DIRECTOR
Credential:
Phone: 714-204-7620