Healthcare Provider Details

I. General information

NPI: 1952327348
Provider Name (Legal Business Name): MISSION TRAUMA SURGICAL MEDICAL GRP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26732 CROWN VALLEY PKWY SUITE 351
MISSION VIEJO CA
92691-6306
US

IV. Provider business mailing address

26732 CROWN VALLEY PKWY SUITE 351
MISSION VIEJO CA
92691-6306
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-1007
  • Fax: 949-364-6057
Mailing address:
  • Phone: 949-364-1007
  • Fax: 949-364-6057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNETTE HANSEN
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 949-364-1007