Provider Demographics
NPI:1982886230
Name:CONSULTANTS FOR CONCEPT DEVELOPMENT
Entity Type:Organization
Organization Name:CONSULTANTS FOR CONCEPT DEVELOPMENT
Other - Org Name:ANAHEIM PRIMARY CARE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JUNSAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-635-0363
Mailing Address - Street 1:1723 W BALL RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5502
Mailing Address - Country:US
Mailing Address - Phone:714-635-0363
Mailing Address - Fax:714-772-2994
Practice Address - Street 1:1723 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5502
Practice Address - Country:US
Practice Address - Phone:714-635-0363
Practice Address - Fax:714-772-2994
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONSULTANTS FOR CONCEPT DEVELOPMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABUS007-02128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A481003Medicaid