Provider Demographics
NPI:1831108901
Name:PRIVATE HOSPITALIST MEDICAL GROUP
Entity Type:Organization
Organization Name:PRIVATE HOSPITALIST MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHRNAZ
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JAMALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-831-0300
Mailing Address - Street 1:26671 ALISO CREEK RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4809
Mailing Address - Country:US
Mailing Address - Phone:949-831-0339
Mailing Address - Fax:
Practice Address - Street 1:26671 ALISO CREEK RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4809
Practice Address - Country:US
Practice Address - Phone:949-831-0339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-06
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30845207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16534Medicare ID - Type Unspecified