Provider Demographics
NPI:1336368422
Name:ASTRA MEDICAL GROUP
Entity Type:Organization
Organization Name:ASTRA MEDICAL GROUP
Other - Org Name:ASTRA PRIMARY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-538-6822
Mailing Address - Street 1:2617 E CHAPMAN AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3248
Mailing Address - Country:US
Mailing Address - Phone:714-538-6822
Mailing Address - Fax:714-280-4510
Practice Address - Street 1:2617 E CHAPMAN AVE STE 205
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3248
Practice Address - Country:US
Practice Address - Phone:714-538-6822
Practice Address - Fax:714-280-4510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAI-77745-L302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF05513Medicare UPIN
CAW13332Medicare PIN
CAE20163Medicare UPIN