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General NPI Number Information
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NPI Number | 1144653346
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Entity Type | Organization
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Legal Business Name | JOHN DI SAIA MD., INC.
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Dates
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Enumeration Date | 08/12/2013
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Last Update Date | 08/12/2013
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Provider Practice Location Address
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Address Line | 3553 CAMINO MIRA COSTA STE A
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3512
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Country | US
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Telephone | 949-369-5932
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Fax |
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Provider Business Mailing Address
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Address Line | 3553 CAMINO MIRA COSTA STE A
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City | SAN CLEMENTE
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State | CA
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Zip | 92672-3512
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Country | US
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Telephone | 949-369-5932
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOHN DI SAIA
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Credential | M.D.
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Telephone | 949-369-5932
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G072451
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License Number State | CA
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