NPI 1578017778

Mesa Advantage Medical Group

Organisation Exclusive Provider Organization San Marino, CA

Practice location

Address: 2295 Huntington Dr # D, San Marino, CA 91108-2640
Phone: (626) 656-2370
Fax: (626) 248-9060

Authorised official

Name: Lan Nhu Bich Phan
Title: Ceo
Phone: (818) 399-8996

Registered specialties (2)

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

Other Exclusive Provider Organization providers in California →

Exclusive Provider Organization

Managed Care Organizations Taxonomy 302F00000X Licence A (CA)

Registry record

NPI: 1578017778
Entity type: Organization
NPI issued: 5 Aug 2016
Record last updated: 21 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.