Healthcare Provider Details

I. General information

NPI: 1326164419
Provider Name (Legal Business Name): DONALD P POWERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STUDENT HEALTH CTR 501 STUDENT HEALTH
IRVINE CA
92697-5200
US

IV. Provider business mailing address

1724 MARLIN WAY
NEWPORT BEACH CA
92660-4328
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-5812
  • Fax: 949-824-1378
Mailing address:
  • Phone: 949-824-5812
  • Fax: 949-824-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA19182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: