Healthcare Provider Details

I. General information

NPI: 1043647258
Provider Name (Legal Business Name): PCI MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 MICHELSON DR SUITE 260
IRVINE CA
92612-1330
US

IV. Provider business mailing address

2151 MICHELSON DR SUITE 260
IRVINE CA
92612-1330
US

V. Phone/Fax

Practice location:
  • Phone: 714-462-8181
  • Fax: 888-504-6948
Mailing address:
  • Phone: 714-462-8181
  • Fax: 888-504-6948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN A NAHM
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-462-8181