Healthcare Provider Details

I. General information

NPI: 1568437440
Provider Name (Legal Business Name): AMDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4870 BARRANCA PKWY SUITE 110
IRVINE CA
92604-4709
US

IV. Provider business mailing address

PO BOX 3699
NEWPORT BEACH CA
92659-8699
US

V. Phone/Fax

Practice location:
  • Phone: 949-857-1248
  • Fax: 949-559-1165
Mailing address:
  • Phone: 949-857-1248
  • Fax: 949-559-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA69508
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberA69508
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License NumberA69508
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL FRAZE
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 310-510-0700