Healthcare Provider Details

I. General information

NPI: 1265525935
Provider Name (Legal Business Name): WESTERN MEDICAL CENTER TRAUMA GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TUSTIN AVE
SANTA ANA CA
92705
US

IV. Provider business mailing address

PO BOX 3428
TUSTIN CA
92781-3428
US

V. Phone/Fax

Practice location:
  • Phone: 714-530-3270
  • Fax:
Mailing address:
  • Phone: 714-289-1559
  • Fax: 714-289-0280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MS. VALERIE KWAN
Title or Position: MANAGER
Credential:
Phone: 626-768-4415