Susan Samueli Center | |
1202 Bristol St Suite 200 Costa Mesa CA 92626-8605 | |
(714) 424-9001 | |
(714) 424-9005 |
Full Name | Susan Samueli Center |
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Speciality | Clinic/center - Multi-specialty |
Location | 1202 Bristol St, Costa Mesa, California |
Authorized Official Name and Position | John A. Heydt (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 7144562986 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Susan Samueli Center Po Box 54509 Los Angeles CA 90054-0509 Ph: (714) 456-6585 | Susan Samueli Center 1202 Bristol St Suite 200 Costa Mesa CA 92626-8605 Ph: (714) 424-9001 |
NPI Number | 1114317872 |
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Provider Enumeration Date | 02/02/2015 |
Last Update Date | 02/02/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1114317872 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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