| Lori J Izabal M D A Professional Corporation | |
|
360 San Miguel Dr Suite 206 Newport Beach CA 92660-7853 | |
| (949) 640-4455 | |
| (949) 640-4456 |
| Full Name | Lori J Izabal M D A Professional Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 360 San Miguel Dr, Newport Beach, California |
| Authorized Official Name and Position | Penny E Hill (PRACTICE MANAGER) |
| Authorized Official Contact | 9496404455 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lori J Izabal M D A Professional Corporation 360 San Miguel Dr Suite 206 Newport Beach CA 92660-7853 Ph: (949) 640-4455 | Lori J Izabal M D A Professional Corporation 360 San Miguel Dr Suite 206 Newport Beach CA 92660-7853 Ph: (949) 640-4455 |
| NPI Number | 1952325532 |
|---|---|
| Provider Enumeration Date | 07/27/2006 |
| Last Update Date | 04/05/2022 |
| Medicare PECOS PAC ID | 2769486125 |
|---|---|
| Medicare Enrollment ID | O20060828000242 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952325532 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | A061528 (California) | Primary |
| Provider Name | Ali R Rafatjoo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154341907 PECOS PAC ID: 6204845662 Enrollment ID: I20060412000384 |
| Provider Name | Lori J Izabal |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114992328 PECOS PAC ID: 9335152156 Enrollment ID: I20060721000264 |
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