=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508046251
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINICA PRENATAL SAN JOSE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/10/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1220 HEMLOCK WAY STE 200
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92707-3655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-966-9795
-----------------------------------------------------
Fax | 714-966-7869
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1220 HEMLOCK WAY STE. 201
-----------------------------------------------------
City | SANTA ANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92707-3650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-966-9795
-----------------------------------------------------
Fax | 714-966-7869
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | ALLAN AKERMAN
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 714-966-9795
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number | A913090
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207VX0000X
-----------------------------------------------------
Taxonomy Name | Obstetrics Physician
-----------------------------------------------------
License Number | G678871
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------