Provider Demographics
NPI:1922090372
Name:ENTRUST MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ENTRUST MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL JUNCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-543-2000
Mailing Address - Street 1:PO BOX 5971
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5971
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:1140 W LA VETA AVE
Practice Address - Street 2:STE. 520
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4225
Practice Address - Country:US
Practice Address - Phone:714-543-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-19
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA0248OtherRAILROAD MEDICARE
ZZZ04646ZOtherBLUE SHIELD OF CA
ZZZ05312ZOtherBLUE SHIELD OF CA
ZZZ04648ZOtherBLUE SHIELD OF CA
ZZZ05316ZOtherBLUE SHIELD OF CA
CAGR0093360Medicaid
CAGR0093362Medicaid
ZZZ05313ZOtherBLUE SHIELD OF CA
ZZZ05314ZOtherBLUE SHIELD OF CA
GR0093362OtherCALOPTIMA
ZZZ04650ZOtherBLUE SHIELD OF CA
ZZZ04647ZOtherBLUE SHIELD OF CA
ZZZ04649ZOtherBLUE SHIELD OF CA
ZZZ05315ZOtherBLUE SHIELD OF CA
ZZZ05317ZOtherBLUE SHIELD OF CA
ZZZ04649ZOtherBLUE SHIELD OF CA