Healthcare Provider Details

I. General information

NPI: 1902570864
Provider Name (Legal Business Name): MAPSONG PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 BROOKHOLLOW DR STE 104
SANTA ANA CA
92705-5428
US

IV. Provider business mailing address

20500 BELSHAW AVENUE DPT XLA 1131
CARSON CA
90746-3506
US

V. Phone/Fax

Practice location:
  • Phone: 949-409-0407
  • Fax: 714-699-3265
Mailing address:
  • Phone: 949-409-0407
  • Fax: 714-699-3265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: AARON BAILEY
Title or Position: GENERAL COUNSEL
Credential:
Phone: 949-409-0407