Basic Information
| Provider Information | |||||||||
| NPI: | 1578829024 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FINFROCK | ||||||||
| FirstName: | MINDY | ||||||||
| MiddleName: | MICHELE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 AVOCADO AVE STE 709 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926608714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497591720 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4968 BOOTH CIR | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926043360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493874900 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2012 | ||||||||
| LastUpdateDate: | 07/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 53631 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.