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General NPI Number Information
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NPI Number | 1972664258
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Entity Type | Organization
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Legal Business Name | BASTANCHURY HEIGHTS MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 09/20/2010
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Provider Practice Location Address
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Address Line | 2264 N STATE COLLEGE BLVD
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City | FULLERTON
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State | CA
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Zip | 92831-1361
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Country | US
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Telephone | 714-255-7045
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Fax | 714-256-4733
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Provider Business Mailing Address
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Address Line | 2264 N STATE COLLEGE BLVD
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City | FULLERTON
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State | CA
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Zip | 92831-1361
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Country | US
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Telephone | 714-255-7045
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Fax | 714-256-4733
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NICHOLAS THANOS
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Credential | M.D.
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Telephone | 714-990-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State | CA
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