Healthcare Provider Details

I. General information

NPI: 1700332368
Provider Name (Legal Business Name): DISCOVERY PRACTICE MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 SOUTHHALL LN STE 175
MAITLAND FL
32751-7176
US

IV. Provider business mailing address

18401 VON KARMAN AVE STE 500
IRVINE CA
92612-8531
US

V. Phone/Fax

Practice location:
  • Phone: 714-828-1800
  • Fax: 714-882-1186
Mailing address:
  • Phone: 714-828-1800
  • Fax: 714-882-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MAGDALEN GUSTILO
Title or Position: DIRECTOR OF PAYER RELATIONS
Credential:
Phone: 714-568-7667