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General NPI Number Information
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NPI Number | 1871648303
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Entity Type | Organization
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Legal Business Name | MISSION COMMUNITY MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 775 N TUSTIN ST
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City | ORANGE
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State | CA
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Zip | 92867-7128
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Country | US
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Telephone | 714-628-8888
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Fax | 714-538-2124
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Provider Business Mailing Address
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Address Line | 775 N TUSTIN ST
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City | ORANGE
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State | CA
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Zip | 92867-7128
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Country | US
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Telephone | 714-628-8888
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Fax | 714-538-2124
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Authorized Official
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Title or Position | OWNER
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Name | SOHRAB SALAMATIPOUR
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Credential | MD
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Telephone | 714-628-8888
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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 | A63781
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License Number State | CA
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