Healthcare Provider Details

I. General information

NPI: 1487947842
Provider Name (Legal Business Name): COMMUNITY OUTREACH MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N. TUSTIN AVE SUITE 130
SANTA ANA CA
92705-3501
US

IV. Provider business mailing address

2171 S. EL CAMINO REAL SUITE 104
OCEANSIDE CA
92054-6269
US

V. Phone/Fax

Practice location:
  • Phone: 657-600-9077
  • Fax: 657-600-9076
Mailing address:
  • Phone: 760-754-5663
  • Fax: 760-754-5440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberA60865
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JACOB NAVA FLORES
Title or Position: CHIEF MEDICAL OFFICER, CMO
Credential: MD
Phone: 760-809-4045