Healthcare Provider Details

I. General information

NPI: 1598676454
Provider Name (Legal Business Name): PROMEDIX DIRECT, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 W MACARTHUR BLVD STE 111
SANTA ANA CA
92704-7939
US

IV. Provider business mailing address

4590 MACARTHUR BLVD STE 500
NEWPORT BEACH CA
92660-2028
US

V. Phone/Fax

Practice location:
  • Phone: 949-702-6900
  • Fax:
Mailing address:
  • Phone: 949-702-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. IRA BEER
Title or Position: EXECUTIVE VP
Credential:
Phone: 949-702-6900