Provider Demographics
NPI:1891217501
Name:BACKBAY HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:BACKBAY HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MURAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-434-0183
Mailing Address - Street 1:2488 NEWPORT BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5196
Mailing Address - Country:US
Mailing Address - Phone:805-704-5705
Mailing Address - Fax:714-886-2570
Practice Address - Street 1:2488 NEWPORT BLVD STE A
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-5196
Practice Address - Country:US
Practice Address - Phone:805-704-5705
Practice Address - Fax:714-886-2570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43078276400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit