| Susan Samueli Center | |
|
1202 Bristol St Suite 200 Costa Mesa CA 92626-8605 | |
| (714) 424-9001 | |
| (714) 424-9005 |
| Full Name | Susan Samueli Center |
|---|---|
| Speciality | Clinic/center - Multi-specialty |
| Location | 1202 Bristol St, Costa Mesa, California |
| Authorized Official Name and Position | Manuel Porto (PRESIDENT & C.E.O.) |
| Authorized Official Contact | 7144562986 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Susan Samueli Center Po Box 54559 Los Angeles CA 90054-0559 Ph: (714) 456-3724 | Susan Samueli Center 1202 Bristol St Suite 200 Costa Mesa CA 92626-8605 Ph: (714) 424-9001 |
| NPI Number | 1588036289 |
|---|---|
| Provider Enumeration Date | 10/21/2015 |
| Last Update Date | 10/21/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588036289 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
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