| |
615 E Chapman Ave Ste 300 Orange CA 92866-1643 | |
(714) 639-4012 | |
(714) 639-4018 |
Full Name | |
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Speciality | Family Medicine |
Location | 615 E Chapman Ave Ste 300, Orange, California |
Authorized Official Name and Position | Arasi Prasad (ADMINISTRATOR) |
Authorized Official Contact | 7146394012 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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615 E Chapman Ave Ste 300 Orange CA 92866-1643 Ph: () - | 615 E Chapman Ave Ste 300 Orange CA 92866-1643 Ph: (714) 639-4012 |
NPI Number | 1730871732 |
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Provider Enumeration Date | 05/26/2023 |
Last Update Date | 03/05/2024 |
Medicare PECOS PAC ID | 8729426135 |
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Medicare Enrollment ID | O20240404001679 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730871732 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Bryn J Henderson |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1447296694 PECOS PAC ID: 1557258928 Enrollment ID: I20040302000547 |
Provider Name | John S Farag |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1104983873 PECOS PAC ID: 5092780627 Enrollment ID: I20040827000768 |
Provider Name | Nicholas E Sieveking |
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Provider Type | Practitioner - Plastic And Reconstructive Surgery |
Provider Identifiers | NPI Number: 1548250434 PECOS PAC ID: 6507937935 Enrollment ID: I20240404001855 |
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