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General NPI Number Information
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NPI Number | 1528465762
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Entity Type | Organization
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Legal Business Name | SANO MEDICAL CLINIC
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Dates
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Enumeration Date | 12/03/2014
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 700 W 19TH ST
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City | COSTA MESA
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State | CA
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Zip | 92627-3517
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Country | US
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Telephone | 949-355-1715
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Fax |
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Provider Business Mailing Address
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Address Line | 700 W 19TH ST
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City | COSTA MESA
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State | CA
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Zip | 92627-3517
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Country | US
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Telephone | 949-355-1715
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. DOLORES STIRBL
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Credential |
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Telephone | 949-355-1715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A30481
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License Number State | CA
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