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General NPI Number Information
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NPI Number | 1619153111
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Entity Type | Organization
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Legal Business Name | SANTA ANA PROHEALTH MEDICAL CLINIC INC
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 999 N TUSTIN AVE STE 22
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City | SANTA ANA
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State | CA
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Zip | 92705-6504
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Country | US
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Telephone | 714-444-9474
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Fax |
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Provider Business Mailing Address
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Address Line | 999 N TUSTIN AVE STE 22
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City | SANTA ANA
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State | CA
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Zip | 92705-6504
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Country | US
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Telephone | 714-444-9474
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Fax |
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Authorized Official
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Title or Position | PRECIDENT
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Name | MASOUD ERIC TAFRESHI
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Credential |
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Telephone | 714-444-9774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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