Healthcare Provider Details

I. General information

NPI: 1487067369
Provider Name (Legal Business Name): NEAL WASHBURN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26401 CROWN VALLEY PKWY STE 101
MISSION VIEJO CA
92691-6302
US

IV. Provider business mailing address

18800 DELAWARE ST STE 1000
HUNTINGTON BEACH CA
92648-6097
US

V. Phone/Fax

Practice location:
  • Phone: 949-348-4000
  • Fax: 949-348-7466
Mailing address:
  • Phone: 714-848-9319
  • Fax: 714-847-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number20A13813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: