# GEORGE O. DETARNOWSKY, JR M.D., INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912176728
- **Authorized official:** MR. GEORGE OLIVIER DETARNOWSKY JR. M.D. (OWNER)
- **Authorized official phone:** (949) 574-5026

## Contact information

- **Practice address:** 355 PLACENTIA AVE, SUITE 300, NEWPORT BEACH, CA 92663-3311
- **Practice address phone:** (949) 574-5026
- **Practice address fax:** (949) 548-8893
- **Mailing address:** 355 PLACENTIA AVE, SUITE 300, NEWPORT BEACH, CA 92663-3311
- **Mailing address phone:** (949) 574-5026
- **Mailing address fax:** (949) 548-8893

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | G41113 | CA | Yes |
| 305R00000X | Preferred Provider Organization | G41113 | CA | — |

## Other

- **Enumeration date:** 02/26/2008
- **Last updated:** 10/21/2008