Organization
MISSION INTERNAL MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DENNIS A WOLIN (CEO)
(949) 282-1617
Entity
Organization
Contact information
Practice address
27871 MEDICAL CENTER RD, SUITE 200, MISSION VIEJO, CA 92691-6404
(949) 347-8314
(949) 364-5427
Mailing address
26522 LA ALAMEDA, SUITE 120, MISSION VIEJO, CA 92691-6330
(949) 282-1671
(949) 367-0518
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
060000510
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SUR01415F
—
CA
Enumeration date
01/09/2006
Last updated
05/24/2010
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