Organization
DHP OF MISSION MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUJAL MANDAVIA M.D. (PRESIDENT)
(865) 693-1000
Entity
Organization
Contact information
Practice address
27700 MEDICAL CENTER RD, MISSION VIEJO, CA 92691-6426
(949) 364-1400
Mailing address
265 BROOKVIEW CENTRE WAY, SUITE 400, KNOXVILLE, TN 37919-4052
(865) 693-1000
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
363A00000X
Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
07/12/2012
Last updated
07/20/2012
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