Basic Information
| Provider Information | |||||||||
| NPI: | 1053784512 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CAREMORE HEALTH PLAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 420 W. CENTRAL AVENUE #A | ||||||||
| Address2: | |||||||||
| City: | BREA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145293971 | ||||||||
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| Practice Location | |||||||||
| Address1: | 420 W. CENTRAL AVENUE #A | ||||||||
| Address2: | |||||||||
| City: | BREA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145293971 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/05/2015 | ||||||||
| LastUpdateDate: | 11/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | PARK | ||||||||
| AuthorizedOfficialFirstName: | TEA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 7145293971 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A90047 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.