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General NPI Number Information
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NPI Number | 1609255215
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Entity Type | Organization
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Legal Business Name | SIX TWO FIVE, INC.
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Dates
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Enumeration Date | 05/28/2015
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Last Update Date | 08/26/2022
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Provider Practice Location Address
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Address Line | 17150 EUCLID ST STE 200
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4092
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Country | US
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Telephone | 714-395-4595
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Fax |
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Provider Business Mailing Address
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Address Line | 1791 N RIDGEWOOD ST
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City | ORANGE
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State | CA
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Zip | 92865-4453
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SARA GHAZI
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Credential | D.O.
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Telephone | 951-316-0657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A13144
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License Number State | CA
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