Organization
SIP DC CA, INC
Active
Other names
MD24 CA Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLENN FORTICH (REVENUE CYCLE MANAGEMENT DIRECTOR)
(626) 893-9730
Entity
Organization
Contact information
Practice address
600 ANTON BLVD STE 1100, COSTA MESA, CA 92626-7100
(800) 388-3906
Mailing address
600 ANTON BLVD STE 1100, COSTA MESA, CA 92626-7100
(800) 388-3906
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
02/20/2015
Last updated
05/25/2021
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