Organization
GEORGE O. DETARNOWSKY, JR M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GEORGE OLIVIER DETARNOWSKY JR. M.D. (OWNER)
(949) 574-5026
Entity
Organization
Contact information
Practice address
355 PLACENTIA AVE, SUITE 300, NEWPORT BEACH, CA 92663-3311
(949) 574-5026
(949) 548-8893
Mailing address
355 PLACENTIA AVE, SUITE 300, NEWPORT BEACH, CA 92663-3311
(949) 574-5026
(949) 548-8893
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
G41113
CA
305R00000X
Preferred Provider Organization
G41113
CA
Other
Enumeration date
02/26/2008
Last updated
10/21/2008
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