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General NPI Number Information
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NPI Number | 1861680712
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Entity Type | Organization
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Legal Business Name | BIENESTAR MEDICAL CENTER, INC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 09/24/2013
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Provider Practice Location Address
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Address Line | 1125 E 17TH ST STE N152
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City | SANTA ANA
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State | CA
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Zip | 92701-2215
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Country | US
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Telephone | 714-285-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 1125 E 17TH ST STE N152
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City | SANTA ANA
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State | CA
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Zip | 92701-2215
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Country | US
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Telephone | 714-285-1100
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MOHAMMAD WALID HASSAN
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Credential | BBS
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Telephone | 714-285-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A61324
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A61671
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A81858
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License Number State | CA
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