Organization
ISTAPHANOUS MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA HAMILTON (PROVIDER ENROLLMENT)
(714) 347-1053
Entity
Organization
Contact information
Practice address
681 S PARKER ST STE 150, ORANGE, CA 92868-4761
(714) 744-0900
(714) 744-9232
Mailing address
210 N TUSTIN AVE, SANTA ANA, CA 92705-3807
(714) 347-1000
(714) 647-1245
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
02/11/2019
Last updated
02/11/2019
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