Organization
DUKE A PHAN MD NEUROLOGY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CORINA SEGOVIA DIAZ (AUTHORIZED OFFICIAL)
(714) 334-1215
Entity
Organization
Contact information
Practice address
17220 NEWHOPE ST, SUITE 217, FOUNTAIN VALLEY, CA 92708-4272
(714) 546-4367
(714) 546-4361
Mailing address
17220 NEWHOPE ST, SUITE 217, FOUNTAIN VALLEY, CA 92708-4272
(714) 546-4367
(714) 546-4361
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
A51193
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A511930
BLUE SHIELD
CA
05
—
00A511930
—
CA
Enumeration date
09/07/2005
Last updated
03/07/2023
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