Provider Demographics
NPI:1639650971
Name:CELVITALI MEDICAL ANAHEIM CENTER
Entity Type:Organization
Organization Name:CELVITALI MEDICAL ANAHEIM CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-488-5168
Mailing Address - Street 1:1174 N EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1174 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1900
Practice Address - Country:US
Practice Address - Phone:714-778-8981
Practice Address - Fax:714-778-8984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-24
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C32413OtherLIC