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General NPI Number Information
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NPI Number | 1720434681
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Entity Type | Organization
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Legal Business Name | PREVENTIVE HEALTHCARE MEDICAL CENTERS
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Dates
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Enumeration Date | 05/10/2016
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Last Update Date | 05/10/2016
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Provider Practice Location Address
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Address Line | 500 SUPERIOR AVE SUITE 100
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3657
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Country | US
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Telephone | 949-566-8414
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 MAIN ST SUITE 360
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City | IRVINE
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State | CA
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Zip | 92614-6237
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Country | US
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Telephone | 949-566-8414
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Fax | 949-872-2370
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES CHARLES LINDBERG I
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Credential | M.D.
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Telephone | 949-566-8414
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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 | G059887
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License Number State | CA
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