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General NPI Number Information
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NPI Number | 1932403441
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Entity Type | Organization
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Legal Business Name | ACESSMD MEDICAL GROUP, INC
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Dates
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Enumeration Date | 12/28/2010
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 17220 NEWHOPE ST #125
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4272
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Country | US
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Telephone | 714-435-0600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8095
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92728-8095
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Country | US
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Telephone | 949-951-9399
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ADEL A BOUTROS
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Credential | MD
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Telephone | 714-317-3084
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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 | G32104
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A47792
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License Number State | CA
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