Provider Demographics
NPI:1720480247
Name:MISSION FAMILY PRACTICE INC
Entity Type:Organization
Organization Name:MISSION FAMILY PRACTICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GLOBUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-614-3090
Mailing Address - Street 1:26902 OSO PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-5801
Mailing Address - Country:US
Mailing Address - Phone:949-916-8870
Mailing Address - Fax:
Practice Address - Street 1:26902 OSO PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5801
Practice Address - Country:US
Practice Address - Phone:949-916-8870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty