Provider Demographics
NPI:1598902660
Name:COSTA MESA MEDICAL CLINIC
Entity Type:Organization
Organization Name:COSTA MESA MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HITESH
Authorized Official - Middle Name:D
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-574-0210
Mailing Address - Street 1:745 W 19TH ST STE F
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3536
Mailing Address - Country:US
Mailing Address - Phone:949-574-0210
Mailing Address - Fax:949-574-0220
Practice Address - Street 1:745 W 19TH ST STE F
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3536
Practice Address - Country:US
Practice Address - Phone:949-574-0210
Practice Address - Fax:949-574-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care