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Organization
TUSTIN IRVINE INTERNAL MEDICINE GROUP INC.
Active
Organization
TUSTIN IRVINE INTERNAL MEDICINE GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIO S FICAROLA M.D. (PRESIDENT)
(714) 838-5610
Entity
Organization
Contact information
Practice address
17400 IRVINE BLVD, SUITE F, TUSTIN, CA 92780-3030
(714) 838-5610
(714) 838-5931
Mailing address
17400 IRVINE BLVD, SUITE F, TUSTIN, CA 92780-3030
(714) 838-5610
(714) 838-5931
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1962544494
NPI
CA
01
—
YYY 42455 Y
BLUE SHIELD
CA
05
—
YYY 42455 Y
—
CA
Enumeration date
03/22/2006
Last updated
06/10/2011
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