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General NPI Number Information
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NPI Number | 1902462732
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Entity Type | Organization
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Legal Business Name | DAVID MIR MD
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Dates
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Enumeration Date | 05/16/2019
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 3300 W COAST HWY STE C
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-4025
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Country | US
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Telephone | 949-842-6607
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7056
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92607-7056
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Country | US
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Telephone | 949-842-6077
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DAVID MIR
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Credential | MD
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Telephone | 949-842-6607
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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