Provider Demographics
NPI:1669859526
Name:PETER JUNGWIRTH,M.D.,INC
Entity type:Organization
Organization Name:PETER JUNGWIRTH,M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JUNGWIRTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-495-4524
Mailing Address - Street 1:15 MAREBLU
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3015
Mailing Address - Country:US
Mailing Address - Phone:949-495-4524
Mailing Address - Fax:949-389-9800
Practice Address - Street 1:15 MAREBLU
Practice Address - Street 2:SUITE 350
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3015
Practice Address - Country:US
Practice Address - Phone:949-495-4524
Practice Address - Fax:949-389-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47721261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49727Medicare UPIN