Healthcare Provider Details

I. General information

NPI: 1497360077
Provider Name (Legal Business Name): CARE CONNECTORS MEDICAL GROUP ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7956 CRESCENT MOON PL
EL PASO TX
79932-1069
US

IV. Provider business mailing address

4695 MACARTHUR CT STE 1112
NEWPORT BEACH CA
92660-1882
US

V. Phone/Fax

Practice location:
  • Phone: 310-927-0919
  • Fax:
Mailing address:
  • Phone: 310-927-0919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VINOD KANNARKAT
Title or Position: PRESIDENT
Credential: MD
Phone: 310-927-0919