| Life Health Care Medical Group Inc | |
|
505 N Tustin Ave Ste 190 Santa Ana CA 92705-3777 | |
| (714) 784-5433 | |
| (714) 784-5438 |
| Full Name | Life Health Care Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 505 N Tustin Ave Ste 190, Santa Ana, California |
| Authorized Official Name and Position | Rafael Arturo Penunuri (MD) |
| Authorized Official Contact | 7147845433 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Life Health Care Medical Group Inc 505 N Tustin Ave Ste 190 Santa Ana CA 92705-3777 Ph: (714) 784-5433 | Life Health Care Medical Group Inc 505 N Tustin Ave Ste 190 Santa Ana CA 92705-3777 Ph: (714) 784-5433 |
| NPI Number | 1417685355 |
|---|---|
| Provider Enumeration Date | 08/09/2022 |
| Last Update Date | 08/09/2022 |
| Medicare PECOS PAC ID | 4587048657 |
|---|---|
| Medicare Enrollment ID | O20220908003238 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417685355 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | Michael K Wensley |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1841336740 PECOS PAC ID: 9739238692 Enrollment ID: I20090522000456 |
| Provider Name | Rafael A Penunuri |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1831270362 PECOS PAC ID: 1759432396 Enrollment ID: I20090622000595 |
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