Healthcare Provider Details

I. General information

NPI: 1023246519
Provider Name (Legal Business Name): CHESHIRE MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2009
Last Update Date: 06/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17232 RED HILL AVE
IRVINE CA
92614-5628
US

IV. Provider business mailing address

17232 RED HILL AVE
IRVINE CA
92614-5628
US

V. Phone/Fax

Practice location:
  • Phone: 949-752-1111
  • Fax: 949-752-1133
Mailing address:
  • Phone: 949-752-1111
  • Fax: 949-752-1133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID WINSTON CHESHIRE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 949-752-1111