Provider Demographics
NPI:1164782421
Name:IRVINE PRIMARY CARE ASSOCIATES MEDICAL GROUP INC
Entity Type:Organization
Organization Name:IRVINE PRIMARY CARE ASSOCIATES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MILLIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-896-9697
Mailing Address - Street 1:825 POLARIS DR
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-1721
Mailing Address - Country:US
Mailing Address - Phone:714-896-9697
Mailing Address - Fax:714-896-8752
Practice Address - Street 1:825 POLARIS DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-1721
Practice Address - Country:US
Practice Address - Phone:714-896-9697
Practice Address - Fax:714-896-8752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty