| |
9191 Bolsa Ave Ste 207, Westminster, CA 92683-5561 | |
(714) 622-4125 | |
(714) 622-4125 |
Full Name | |
---|---|
Type | Facility |
Speciality | Specialist |
Location | 9191 Bolsa Ave Ste 207, Westminster, California |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1932161007 | NPI | - | NPPES |
AC0062610 | Other | CA | MEDI-CAL PROVIDER NUMBER |
Mailing Address | Practice Location Address |
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9191 Bolsa Ave Ste 207, Westminster, CA 92683-5561 Ph: (714) 622-4125 | 9191 Bolsa Ave Ste 207, Westminster, CA 92683-5561 Ph: (714) 622-4125 |