Provider Demographics
NPI: | 1710444096 |
---|---|
Name: | ALISON METHERELL, MD, MPH, A PROFESSIONAL CORPORATION |
Entity Type: | Organization |
Organization Name: | ALISON METHERELL, MD, MPH, A PROFESSIONAL CORPORATION |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ALISON |
Authorized Official - Middle Name: | M |
Authorized Official - Last Name: | MANN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 310-770-2521 |
Mailing Address - Street 1: | PO BOX 1813 |
Mailing Address - Street 2: | |
Mailing Address - City: | SUISUN CITY |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94585-4813 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 657-241-3600 |
Mailing Address - Fax: | 657-241-7708 |
Practice Address - Street 1: | 1190 W. BAKER STREET STE 103 |
Practice Address - Street 2: | |
Practice Address - City: | COSTA MESA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92626-4105 |
Practice Address - Country: | US |
Practice Address - Phone: | 714-668-2525 |
Practice Address - Fax: | 714-668-2530 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-02-22 |
Last Update Date: | 2023-10-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Single Specialty |