Healthcare Provider Details

I. General information

NPI: 1740822360
Provider Name (Legal Business Name): SAINT YOUSTINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 S MAIN ST APT A
SANTA ANA CA
92701-6605
US

IV. Provider business mailing address

PO BOX 10875
COSTA MESA CA
92627-0268
US

V. Phone/Fax

Practice location:
  • Phone: 714-973-7770
  • Fax: 714-973-7775
Mailing address:
  • Phone: 714-973-7770
  • Fax: 714-973-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ISAAC NAGEEB BESHAY
Title or Position: CEO
Credential: MD
Phone: 714-290-6269