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General NPI Number Information
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NPI Number | 1467163840
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Entity Type | Organization
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Legal Business Name | MULBERRY MEDICAL GROUP, INC
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Dates
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Enumeration Date | 12/07/2022
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Last Update Date | 12/07/2022
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Provider Practice Location Address
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Address Line | 7630 E CHAPMAN AVE STE B
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City | ORANGE
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State | CA
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Zip | 92869-8536
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Country | US
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Telephone | 714-287-0459
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Fax | 714-699-9030
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Provider Business Mailing Address
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Address Line | 7630 E CHAPMAN AVE STE B
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City | ORANGE
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State | CA
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Zip | 92869-8536
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Country | US
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Telephone | 714-287-0459
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Fax | 714-699-9030
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Authorized Official
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Title or Position | PRESIDENT
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Name | NATHANIEL DENICOLA
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Credential | MD
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Telephone | 714-287-0459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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