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General NPI Number Information
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NPI Number | 1629562954
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Entity Type | Organization
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Legal Business Name | TRUCARE MEDICAL CENTER INC.
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Dates
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Enumeration Date | 06/20/2018
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 24541 PACIFIC PARK DR STE 109
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3050
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Country | US
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Telephone | 949-346-3584
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Fax |
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Provider Business Mailing Address
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Address Line | 24541 PACIFIC PARK DR STE 109
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City | ALISO VIEJO
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State | CA
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Zip | 92656-3050
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Country | US
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Telephone | 949-346-3584
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Fax |
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Authorized Official
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Title or Position | OWNER/MEDICAL DIRECTOR
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Name | BARRY M BLUMENTHAL
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Credential | DO
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Telephone | 949-346-3584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 16428
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License Number State | CA
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