Healthcare Provider Details

I. General information

NPI: 1619272531
Provider Name (Legal Business Name): SYNERGY HEALTH CONCEPTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 BIRCH ST SUITE A
NEWPORT BEACH CA
92660-1990
US

IV. Provider business mailing address

4501 BIRCH ST SUITE A
NEWPORT BEACH CA
92660-1990
US

V. Phone/Fax

Practice location:
  • Phone: 626-616-5114
  • Fax:
Mailing address:
  • Phone: 626-616-5114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL A. ARATA
Title or Position: PRESIDENT
Credential: MD
Phone: 949-221-0129