Provider Demographics
NPI:1891148102
Name:COMMUNITY PERFORMANCERX MSO, LLC
Entity Type:Organization
Organization Name:COMMUNITY PERFORMANCERX MSO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VOLPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-313-6470
Mailing Address - Street 1:9701 JERONIMO RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2076
Mailing Address - Country:US
Mailing Address - Phone:800-960-8147
Mailing Address - Fax:
Practice Address - Street 1:9701 JERONIMO RD
Practice Address - Street 2:SUITE 300
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2076
Practice Address - Country:US
Practice Address - Phone:800-960-8147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Multi-Specialty
No364SC2300XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistChronic CareGroup - Multi-Specialty