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Organization
ST, JUDE HERITAGE MEDICAL GROUP
Active
Organization
ST, JUDE HERITAGE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BOB O'NEIL (VP OF PHYSICIAN SERVICES)
(714) 578-8616
Entity
Organization
Contact information
Practice address
731 S HIGHLAND AVE, FULLERTON, CA 92832-2753
(714) 446-5100
Mailing address
731 S. HIGHLAND AVE, FULLERTON, CA 92832-2753
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
21377
CA
Other
Enumeration date
11/23/2011
Last updated
11/23/2011
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