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General NPI Number Information
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NPI Number | 1598902660
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Entity Type | Organization
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Legal Business Name | COSTA MESA MEDICAL CLINIC
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Dates
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Enumeration Date | 01/12/2009
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 745 W 19TH ST STE F
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City | COSTA MESA
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State | CA
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Zip | 92627-3536
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Country | US
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Telephone | 949-574-0210
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Fax | 949-574-0220
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Provider Business Mailing Address
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Address Line | 745 W 19TH ST STE F
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City | COSTA MESA
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State | CA
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Zip | 92627-3536
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Country | US
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Telephone | 949-574-0210
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Fax | 949-574-0220
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. HITESH D. PATEL
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Credential | MD
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Telephone | 949-574-0210
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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 |
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License Number State |
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