Healthcare Provider Details

I. General information

NPI: 1306248240
Provider Name (Legal Business Name): PACIFIC HOSPITALIST ASSOCIATES A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2014
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 SUPERIOR AVE
NEWPORT BEACH CA
92663-3628
US

IV. Provider business mailing address

361 HOSPITAL RD STE 521
NEWPORT BEACH CA
92663-3526
US

V. Phone/Fax

Practice location:
  • Phone: 949-646-7764
  • Fax: 949-574-5633
Mailing address:
  • Phone: 949-873-6181
  • Fax: 949-873-0418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberFNP28511
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. WESTON CHANDLER
Title or Position: PRESIDENT
Credential: MD
Phone: 949-873-6181