Healthcare Provider Details

I. General information

NPI: 1639702004
Provider Name (Legal Business Name): APEX EMERGENCY MEDICAL GROUP - SOUTH COAST INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 S BRISTOL ST
SANTA ANA CA
92704-6201
US

IV. Provider business mailing address

PO BOX 400
HEMET CA
92546-0400
US

V. Phone/Fax

Practice location:
  • Phone: 714-754-5454
  • Fax:
Mailing address:
  • Phone: 626-447-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD C. HANNA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 626-447-0296