| La Veta Office | |
|
1010 W La Veta Ave Suite 750 Orange CA 92868-4304 | |
| (714) 361-6600 | |
| Not Available |
| Full Name | La Veta Office |
|---|---|
| Speciality | Internal Medicine |
| Location | 1010 W La Veta Ave, Orange, California |
| Authorized Official Name and Position | Jack Stewart (PRESIDENT - AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 7146399401 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| La Veta Office 1010 W La Veta Ave Suite 750 Orange CA 92868-4312 Ph: (714) 361-6600 | La Veta Office 1010 W La Veta Ave Suite 750 Orange CA 92868-4304 Ph: (714) 361-6600 |
| NPI Number | 1447410519 |
|---|---|
| Provider Enumeration Date | 06/12/2008 |
| Last Update Date | 06/21/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447410519 | NPI | - | NPPES |
| 1912919804 | Medicaid | CA | |
| CG5665 | Other | CA | RAILROAD MEDICARE GROUP NUMBER |
| 1912919804 | Other | CA | TYPE 2 NPI |
| W1514 | Other | CA | TYPE 2 PTAN |
| GR0003350 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 207RP1001X | Internal Medicine - Pulmonary Disease | (* (Not Available)) | Secondary |
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