Healthcare Provider Details

I. General information

NPI: 1356669790
Provider Name (Legal Business Name): PACIFIC HOSPITALIST ASSOCIATES A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2010
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 SAND CANYON AVE
IRVINE CA
92618
US

IV. Provider business mailing address

361 HOSPITAL RD STE 521
NEWPORT BEACH CA
92663-3526
US

V. Phone/Fax

Practice location:
  • Phone: 949-873-6181
  • Fax: 949-873-0418
Mailing address:
  • Phone: 949-873-6181
  • Fax: 949-873-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberFNP28511
License Number StateCA

VIII. Authorized Official

Name: DR. WESTON CHANDLER
Title or Position: PRESIDENT
Credential:
Phone: 949-873-6181