Healthcare Provider Details

I. General information

NPI: 1417685355
Provider Name (Legal Business Name): LIFE HEALTH CARE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N TUSTIN AVE STE 190
SANTA ANA CA
92705-3777
US

IV. Provider business mailing address

505 N TUSTIN AVE STE 190
SANTA ANA CA
92705-3777
US

V. Phone/Fax

Practice location:
  • Phone: 714-784-5433
  • Fax: 714-784-5438
Mailing address:
  • Phone: 714-784-5433
  • Fax: 714-784-5438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. RAFAEL ARTURO PENUNURI
Title or Position: MD
Credential: MD
Phone: 714-784-5433