Provider Demographics
NPI:1912586306
Name:COMPLETE CARE MEDICAL GROUP PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:COMPLETE CARE MEDICAL GROUP PROFESSIONAL CORPORATION
Other - Org Name:COMPLETE CARE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLLIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-861-4177
Mailing Address - Street 1:4902 IRVINE CENTER DR STE 103
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-3334
Mailing Address - Country:US
Mailing Address - Phone:949-861-4177
Mailing Address - Fax:949-861-4178
Practice Address - Street 1:4902 IRVINE CENTER DR STE 103
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3334
Practice Address - Country:US
Practice Address - Phone:949-861-4177
Practice Address - Fax:949-861-4178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-05
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty