Healthcare Provider Details

I. General information

NPI: 1891981502
Provider Name (Legal Business Name): HEALTHCARE PARTNERS AFFILIATES MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14591 NEWPORT AVE
TUSTIN CA
92780-6001
US

IV. Provider business mailing address

PO BOX 6400
TORRANCE CA
90504-0400
US

V. Phone/Fax

Practice location:
  • Phone: 714-442-4864
  • Fax:
Mailing address:
  • Phone: 310-525-3869
  • Fax: 310-783-5581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. REBECCA D. SCHAUMBURG
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 310-525-3869