Healthcare Provider Details

I. General information

NPI: 1407541626
Provider Name (Legal Business Name): TRIUMPH HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2023
Last Update Date: 04/05/2023
Certification Date: 04/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27272 DELEMOS
MISSION VIEJO CA
92692-3246
US

IV. Provider business mailing address

30251 GOLDEN LANTERN STE E415
LAGUNA NIGUEL CA
92677-5993
US

V. Phone/Fax

Practice location:
  • Phone: 949-446-9973
  • Fax: 209-297-4085
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCEE BUSTILLOS-PATRICK
Title or Position: EXECUTIVE DIRECTOR/CEO
Credential:
Phone: 949-446-9906