Organization
MESA ADVANTAGE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAN NHU BICH PHAN (CEO)
(818) 399-8996
Entity
Organization
Contact information
Practice address
2295 HUNTINGTON DR # D, SAN MARINO, CA 91108-2640
(626) 656-2370
(626) 248-9060
Mailing address
2295 HUNTINGTON DR # D, SAN MARINO, CA 91108-2640
(626) 656-2370
(626) 248-9060
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
A
CA
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
08/05/2016
Last updated
07/21/2022
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