MEDICARE: DISCOVERY PRACTICE MANAGEMENT, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1528791480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISCOVERY PRACTICE MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	18401 VON KARMAN AVE STE 500
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92612-8531
Country	:	US
Telephone Number	:	714-828-1800
Fax Number	:	714-882-1186

Provider Business Practice Location Address
First Line	:	4711 44TH AVE SW STE A
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98116-4401
Country	:	US
Telephone Number	:	714-828-1800
Fax Number	:	714-882-1186

Authorized Official
Title or Position	:	DIRECTOR OF PAYER RELATIONS
Name	:	MAGDALEN GUSTILO
Credential	:
Telephone Number	:	714-568-7667

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	05/10/2023

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