Healthcare Provider Details

I. General information

NPI: 1114218351
Provider Name (Legal Business Name): CORY DANIEL MCNAMARA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 NEWPORT CENTER DR STE 235
NEWPORT BEACH CA
92660-0903
US

IV. Provider business mailing address

62 DIAMOND FLTS
IRVINE CA
92602-1846
US

V. Phone/Fax

Practice location:
  • Phone: 949-999-4120
  • Fax: 949-999-1698
Mailing address:
  • Phone: 310-918-7497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA146120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: