Provider Demographics
NPI:1386856441
Name:FIRST HOPE MEDICAL CLINIC INC.
Entity Type:Organization
Organization Name:FIRST HOPE MEDICAL CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-543-5005
Mailing Address - Street 1:999 N. TUSTIN AVE.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705
Mailing Address - Country:US
Mailing Address - Phone:714-543-5005
Mailing Address - Fax:714-543-5595
Practice Address - Street 1:999 N. TUSTIN AVE.
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705
Practice Address - Country:US
Practice Address - Phone:714-543-5005
Practice Address - Fax:714-543-5595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30241174400000X
CAA-91300174400000X
CADC24524174400000X
CAA38937174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty