| Share Our Selves Community Health Center | |
|
1550 Superior Ave Costa Mesa CA 92627-3653 | |
| (949) 270-2100 | |
| (949) 515-5804 |
| Full Name | Share Our Selves Community Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1550 Superior Ave, Costa Mesa, California |
| Authorized Official Name and Position | Christy Ward (CEO) |
| Authorized Official Contact | 9495363927 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Share Our Selves Community Health Center Po Box 10159 Costa Mesa CA 92627-0050 Ph: (949) 270-2100 | Share Our Selves Community Health Center 1550 Superior Ave Costa Mesa CA 92627-3653 Ph: (949) 270-2100 |
| NPI Number | 1508073685 |
|---|---|
| Provider Enumeration Date | 05/17/2007 |
| Last Update Date | 10/02/2020 |
| Medicare PECOS PAC ID | 4789854993 |
|---|---|
| Medicare Enrollment ID | O20110825000722 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508073685 | NPI | - | NPPES |
| CMM70513F | Other | CA | MEDI-CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Jay W Lee |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548201726 PECOS PAC ID: 2961437587 Enrollment ID: I20051003000698 |
| Provider Name | Nazanin Sanaei |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1477737161 PECOS PAC ID: 4183761810 Enrollment ID: I20091028000463 |
| Provider Name | Sabrina J Cooley |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629272588 PECOS PAC ID: 3870775992 Enrollment ID: I20110310000909 |
| Provider Name | Teresa Flores |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770852659 PECOS PAC ID: 1456573070 Enrollment ID: I20141117000372 |
| Provider Name | Jasmine Le |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710380654 PECOS PAC ID: 5991022899 Enrollment ID: I20150401001957 |
| Provider Name | Stacey Cabrera Sanchez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1427460419 PECOS PAC ID: 1759695026 Enrollment ID: I20150730011800 |
| Provider Name | Nicole Annmarie Vidal |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376903724 PECOS PAC ID: 1850690785 Enrollment ID: I20160427002470 |
| Provider Name | Edwin Kyunghun Kwon |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1487097846 PECOS PAC ID: 0648562801 Enrollment ID: I20160707002466 |
| Provider Name | Eric Hargis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1093104309 PECOS PAC ID: 7719279710 Enrollment ID: I20160712002640 |
| Provider Name | Luigi Ayston Cendana |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1982025185 PECOS PAC ID: 7315223377 Enrollment ID: I20170406000862 |
| Provider Name | Cecilia Tien Dinh |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831500917 PECOS PAC ID: 7113220948 Enrollment ID: I20180917000474 |
| Provider Name | Cheryl Ann Thomas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992760573 PECOS PAC ID: 7214109859 Enrollment ID: I20181218002378 |
| Provider Name | Patricia Bruce |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1346426921 PECOS PAC ID: 6305929605 Enrollment ID: I20190326000648 |
| Provider Name | Jill Johnston |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134612500 PECOS PAC ID: 5890033906 Enrollment ID: I20200302001966 |
| Provider Name | Jessica Brito |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033574454 PECOS PAC ID: 6406275791 Enrollment ID: I20201006002802 |
| Provider Name | Laura Serratos De La Rosa |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609117712 PECOS PAC ID: 5193093920 Enrollment ID: I20201015001403 |
| Provider Name | Earl S Trinidad |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558836999 PECOS PAC ID: 5092054312 Enrollment ID: I20201021000078 |
| Provider Name | Darin Lee Rorrer |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1912321472 PECOS PAC ID: 3678987757 Enrollment ID: I20210201002063 |
| Provider Name | Laela Mae Hajiaghamohseni |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1316252141 PECOS PAC ID: 6800204892 Enrollment ID: I20210412001085 |
| Provider Name | Claudia Alicia Rodriguez-zinn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205440377 PECOS PAC ID: 3577968940 Enrollment ID: I20210823003092 |
| Provider Name | Aundrea Michelle Paxton |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1316379704 PECOS PAC ID: 0648647891 Enrollment ID: I20221101002756 |
| Provider Name | Antigone Anna Gonis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366902199 PECOS PAC ID: 1658748322 Enrollment ID: I20221109001772 |
| Provider Name | Phuong Quy Tran |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104240928 PECOS PAC ID: 2466703376 Enrollment ID: I20221115003129 |
| Provider Name | Tori Rachel Kretschmer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578284600 PECOS PAC ID: 7315317526 Enrollment ID: I20230104002896 |
| Provider Name | Anjali Vora |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1326248170 PECOS PAC ID: 2062600356 Enrollment ID: I20230221001069 |
| Provider Name | Delvin S Endsley |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750512026 PECOS PAC ID: 6709927429 Enrollment ID: I20230329001905 |
| Provider Name | Florence Yuan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962031518 PECOS PAC ID: 1254732514 Enrollment ID: I20230922002786 |
| Provider Name | Hanna Rachel Kleiner |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437554029 PECOS PAC ID: 8527417740 Enrollment ID: I20231213003493 |
| Provider Name | Cinthya Isabel Pasallo |
|---|---|
| Provider Type | Practitioner - Other (physician) |
| Provider Identifiers | NPI Number: 1467942060 PECOS PAC ID: 9032561600 Enrollment ID: I20240118004181 |
Nazli Ahmed, M.d., Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 275 Victoria St, # 2m, Costa Mesa, CA 92627 Phone: 949-642-5390 Fax: 949-642-1224 | |
Roberto N Valenton Md Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 301 Victoria St, Costa Mesa, CA 92627 Phone: 949-642-2734 | |
Bristol Park Medical Group, Inc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 722 Baker St, Costa Mesa, CA 92626 Phone: 714-557-6300 Fax: 714-966-9567 | |
Shahrestani Chiropractic Professional Corporation Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 2328 Newport Blvd, Costa Mesa, CA 92627 Phone: 949-631-3139 Fax: 949-631-0747 | |
Md24 San Diego, Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 600 Anton Blvd Ste 1100, Costa Mesa, CA 92626 Phone: 623-374-7774 | |
Coastal Mesa Corp. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 777 W 19th St Ste J, Costa Mesa, CA 92627 Phone: 657-203-2133 | |
Newport Mesa Medical Group, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 275 Victoria St, Ste 1e, Costa Mesa, CA 92627 Phone: 949-574-3615 |