Healthcare Provider Details

I. General information

NPI: 1578523692
Provider Name (Legal Business Name): PHILIP E MADRID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 E CHAPMAN AVE SUITE 203
ORANGE CA
92869-3223
US

IV. Provider business mailing address

2501 E CHAPMAN AVE SUITE 203
ORANGE CA
92869-3223
US

V. Phone/Fax

Practice location:
  • Phone: 714-628-3340
  • Fax: 714-633-7349
Mailing address:
  • Phone: 714-628-3340
  • Fax: 714-633-7349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA45165
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: