Healthcare Provider Details

I. General information

NPI: 1588028666
Provider Name (Legal Business Name): RADIANT PHYSICIAN GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18231 IRVINE BLVD SUITE 204
TUSTIN CA
92780-3432
US

IV. Provider business mailing address

18231 IRVINE BLVD SUITE 204
TUSTIN CA
92780-3432
US

V. Phone/Fax

Practice location:
  • Phone: 714-389-5700
  • Fax: 714-389-6973
Mailing address:
  • Phone: 714-389-5700
  • Fax: 714-389-6973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT AMSTER
Title or Position: CMO
Credential: M.D.
Phone: 714-389-5700