Healthcare Provider Details

I. General information

NPI: 1992572234
Provider Name (Legal Business Name): SANTA MARIA MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E MCFADDEN AVE STE D
SANTA ANA CA
92705-4647
US

IV. Provider business mailing address

1701 E MCFADDEN AVE STE D
SANTA ANA CA
92705-4647
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-6430
  • Fax:
Mailing address:
  • Phone: 714-953-6430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KAVEH KARANDISH
Title or Position: CEO/OWNER
Credential: MD
Phone: 714-953-6430