Provider Demographics
NPI:1669509170
Name:21ST CENTURY MEDICAL CORP.
Entity Type:Organization
Organization Name:21ST CENTURY MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-851-8185
Mailing Address - Street 1:1921 CARNEGIE AVE
Mailing Address - Street 2:SUITE 3-K
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-5510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1921 CARNEGIE AVE
Practice Address - Street 2:SUITE 3-K
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-5510
Practice Address - Country:US
Practice Address - Phone:949-851-8185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare