Healthcare Provider Details

I. General information

NPI: 1659505402
Provider Name (Legal Business Name): NONSURGICAL MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 S HARBOR BLVD SUITE B
SANTA ANA CA
92704-7901
US

IV. Provider business mailing address

3801 S HARBOR BLVD SUITE B
SANTA ANA CA
92704-7901
US

V. Phone/Fax

Practice location:
  • Phone: 714-751-5555
  • Fax: 714-751-9999
Mailing address:
  • Phone: 714-751-5555
  • Fax: 714-751-9999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA52791
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT12558
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA52791
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC12991
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberG17592
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES PATRICK HALL
Title or Position: PRESIDENT
Credential: D.C.
Phone: 714-751-5555