Provider Demographics
NPI:1174833149
Name:THE MISSION MEDICAL CLINIC OF SANTA ANA, INC.
Entity Type:Organization
Organization Name:THE MISSION MEDICAL CLINIC OF SANTA ANA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:RAUL
Authorized Official - Last Name:DI SARLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-558-6800
Mailing Address - Street 1:1514 N SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-2332
Mailing Address - Country:US
Mailing Address - Phone:714-558-6800
Mailing Address - Fax:714-558-7600
Practice Address - Street 1:1514 N SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2332
Practice Address - Country:US
Practice Address - Phone:714-558-6800
Practice Address - Fax:714-558-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA36991207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty