Healthcare Provider Details

I. General information

NPI: 1003562398
Provider Name (Legal Business Name): JMC MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WESTCLIFF DR STE 301
NEWPORT BEACH CA
92660-5553
US

IV. Provider business mailing address

2001 WESTCLIFF DR STE 301
NEWPORT BEACH CA
92660-5553
US

V. Phone/Fax

Practice location:
  • Phone: 617-784-4682
  • Fax:
Mailing address:
  • Phone: 617-784-4682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JORGE MAURICIO CASTELLANOS
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 617-784-4682