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General NPI Number Information
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NPI Number | 1104960749
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Entity Type | Organization
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Legal Business Name | S M MULTISPECIALTY MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 2492 WALNUT AVE SUITE 110
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City | TUSTIN
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State | CA
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Zip | 92780-6953
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Country | US
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Telephone | 714-669-1997
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Fax | 714-573-7424
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Provider Business Mailing Address
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Address Line | 2492 WALNUT AVE SUITE 110
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City | TUSTIN
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State | CA
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Zip | 92780-6953
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Country | US
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Telephone | 714-669-1997
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Fax | 714-573-7424
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUNIL MAPARA
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Credential |
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Telephone | 714-970-0911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 20A8503
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A37744
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License Number State | CA
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