Provider Demographics
NPI:1356545529
Name:PUREZA, ANTHONY R
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:R
Last Name:PUREZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6100
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-6100
Mailing Address - Country:US
Mailing Address - Phone:323-226-2170
Mailing Address - Fax:323-226-5760
Practice Address - Street 1:1 ONE HOAG DRIVE,
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6100
Practice Address - Country:US
Practice Address - Phone:323-226-2170
Practice Address - Fax:323-226-5760
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95874207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW809AMedicare ID - Type UnspecifiedROYBAL
CAW809FMedicare ID - Type UnspecifiedEL MONTE
CAW932Medicare ID - Type UnspecifiedHEALTH CENTERS
CAW809BMedicare ID - Type UnspecifiedHUDSON