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General NPI Number Information
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NPI Number | 1790367779
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH - ST. THERESA MEDICAL, INC.
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 11180 WARNER AVE
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7501
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Country | US
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Telephone | 714-760-4903
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Fax | 714-760-4349
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Provider Business Mailing Address
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Address Line | 11180 WARNER AVE
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7501
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Country | US
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Telephone | 714-760-4903
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Fax | 714-760-4349
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Authorized Official
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Title or Position | OWNER / MEDICAL DOCTOR
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Name | LILY H DO
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Credential | DO
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Telephone | 714-760-4903
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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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