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General NPI Number Information
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NPI Number | 1639650971
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Entity Type | Organization
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Legal Business Name | CELVITALI MEDICAL ANAHEIM CENTER
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 12/13/2018
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Provider Practice Location Address
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Address Line | 1174 N EUCLID ST
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City | ANAHEIM
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State | CA
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Zip | 92801-1900
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Country | US
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Telephone | 714-778-8981
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Fax | 714-778-8984
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Provider Business Mailing Address
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Address Line | 1174 N EUCLID ST
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City | ANAHEIM
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State | CA
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Zip | 92801-1900
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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 | ADMINISTRATOR
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Name | CECILIA LEE CHENG
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Credential |
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Telephone | 310-488-5168
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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 |
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License Number State |
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