Healthcare Provider Details

I. General information

NPI: 1306431341
Provider Name (Legal Business Name): OMID VESAL, MD, MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 03/02/2021
Certification Date: 02/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALTON PKWY STE 101
IRVINE CA
92606-5032
US

IV. Provider business mailing address

2500 ALTON PKWY STE 101
IRVINE CA
92606-5032
US

V. Phone/Fax

Practice location:
  • Phone: 949-222-2722
  • Fax:
Mailing address:
  • Phone: 949-222-2722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. OMID VESAL
Title or Position: OWNER
Credential: MD
Phone: 949-222-2722