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COLLEGE MEDICAL GROUP INC. NPI 1760532543


NPI Information

NPI: 1760532543
Provider Name: COLLEGE MEDICAL GROUP, INC.
Classification: Clinic/Center - 261Q00000X
Entity Type: Organization
Address:
611 S MAIN ST
SUITE A
SANTA ANA, CA
ZIP 92701
Phone: (714) 564-9323
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COLLEGE MEDICAL GROUP, INC. is a clinic center in Santa Ana, CA. The provider is a facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). COLLEGE MEDICAL GROUP, INC. NPI is 1760532543. The provider is registered as an organization entity type.

The provider's business location address is:

611 S MAIN ST
SUITE A
SANTA ANA, CA
ZIP 92701-715
Phone: (714) 564-9323
Fax: (714) 973-8885

The provider's authorized official is Somsong Wattanasakul Tongbai .
The authorized official title is President and has the following contact phone number (714) 564-9323.

The enumeration date for this NPI number is 1/12/2007 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261Q00000XClinic/CenterA31437CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100A314370-151OTHERCALIFORNIACALOPTIMA PROVIDER NUMBER
2GR0011541OTHERCALIFORNIAMEDI-CAL PROVIDER NUMBER
3GR0011541OTHERCALIFORNIACHDP PROVIDER NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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