| Tustin Irvine Internal Medicine Group Inc. | |
|
17400 Irvine Blvd Suite F Tustin CA 92780-3030 | |
| (714) 838-5610 | |
| (714) 838-5931 |
| Full Name | Tustin Irvine Internal Medicine Group Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 17400 Irvine Blvd, Tustin, California |
| Authorized Official Name and Position | Mario S Ficarola (PRESIDENT) |
| Authorized Official Contact | 7148385610 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tustin Irvine Internal Medicine Group Inc. 17400 Irvine Blvd Suite F Tustin CA 92780-3030 Ph: (714) 838-5610 | Tustin Irvine Internal Medicine Group Inc. 17400 Irvine Blvd Suite F Tustin CA 92780-3030 Ph: (714) 838-5610 |
| NPI Number | 1689633125 |
|---|---|
| Provider Enumeration Date | 03/22/2006 |
| Last Update Date | 06/10/2011 |
| Medicare PECOS PAC ID | 9830134857 |
|---|---|
| Medicare Enrollment ID | O20050621000648 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689633125 | NPI | - | NPPES |
| YYY 42455 Y | Other | CA | BLUE SHIELD |
| 1962544494 | Other | CA | NPI |
| YYY 42455 Y | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Susan L Ban |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053324970 PECOS PAC ID: 0648245795 Enrollment ID: I20040831001600 |
| Provider Name | Thomas C Hwang |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1124039722 PECOS PAC ID: 1951306646 Enrollment ID: I20061002000690 |
| Provider Name | Huong T Duong |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013020437 PECOS PAC ID: 5991741159 Enrollment ID: I20090804000109 |
| Provider Name | Mario S Ficarola |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1104939529 PECOS PAC ID: 4082650247 Enrollment ID: I20090805000306 |
| Provider Name | Julia C Motherway |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1962544494 PECOS PAC ID: 0345394730 Enrollment ID: I20090819000816 |
| Provider Name | Neil D Patel |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1235767716 PECOS PAC ID: 7719396464 Enrollment ID: I20230927003733 |
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