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Organization
GEORGE O. DETARNOWSKY, JR M.D., INC.
Active
Organization
GEORGE O. DETARNOWSKY, JR M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE OLIVIER DETARNOWSKY JR. M.D. (OWNER)
(949) 574-5026
Entity
Organization
Contact information
Practice address
355 PLACENTIA AVE, SUITE 300, NEWPORT BEACH, CA 92663-3311
(949) 574-5026
(949) 548-8893
Mailing address
355 PLACENTIA AVE, SUITE 300, NEWPORT BEACH, CA 92663-3311
(949) 574-5026
(949) 548-8893
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
G41113
CA
305R00000X
Preferred Provider Organization
G41113
CA
Other
Enumeration date
02/26/2008
Last updated
10/21/2008
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