Healthcare Provider Details

I. General information

NPI: 1730163965
Provider Name (Legal Business Name): JOEL M NEUTEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14351 MYFORD RD SUITE B
TUSTIN CA
92780-7045
US

IV. Provider business mailing address

14351 MYFORD RD STE B
TUSTIN CA
92780-1932
US

V. Phone/Fax

Practice location:
  • Phone: 714-550-9990
  • Fax: 714-550-1226
Mailing address:
  • Phone: 714-550-9990
  • Fax: 714-730-4106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA50551
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA50551
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: