SUSAN SAMUELI CENTER (NPI# 1114317872) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114317872 |
| Entity Type | Organization |
| Organization Name | SUSAN SAMUELI CENTER |
| Practice Address |
1202 Bristol St Suite 200 Costa Mesa CA 92626-8605 |
| Mailing Address |
Po Box 54509 Los Angeles CA 90054-0509 |
| Practice Telephone | 7144249001 |
| Practice Fax Number | 7144249005 |
| Mailing Telephone | 7144566585 |
| Mailing Fax Number | 7144568101 |
| Enumeration Date | 2015-02-02 |
| Last Update Date | 2015-02-02 |
| Authorized Official Name | JOHN A. HEYDT (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 7144562986 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | REGENTS OF THE UNIVERSITY OF CALIFORNIA |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770955593 | Susan Samueli Center | Clinic/Center | 1202 Bristol St, Suite 200, Costa Mesa, CA 92626-8605 | 2015-10-21 |
| 1588036289 | Susan Samueli Center | Clinic/Center | 1202 Bristol St, Suite 200, Costa Mesa, CA 92626-8605 | 2015-10-21 |
| Street Address |
1202 BRISTOL ST SUITE 200 |
| City | COSTA MESA |
| State | CA |
| Zip Code | 92626-8605 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427556539 | Maggie Beth Quinn | Naturopath | 1202 Bristol St, Costa Mesa, CA 92626-8605 | 2018-01-24 |
| 1760932917 | Rowena Daly | Naturopath | 1202 Bristol St, Costa Mesa, CA 92626-8605 | 2016-10-12 |
| 1649720798 | Michael Palladino | Naturopath | 1202 Bristol St, Uc Irvine - Susan Samueli Center for Integrative Med., Costa Mesa, CA 92626-8605 | 2016-10-12 |
| 1508225111 | Leila Astarabadi | Mechanotherapist | 1202 Bristol St, 2nd Floor, Costa Mesa, CA 92626-8605 | 2016-02-11 |
| 1770955593 | Susan Samueli Center | Clinic/Center | 1202 Bristol St, Suite 200, Costa Mesa, CA 92626-8605 | 2015-10-21 |
| 1588036289 | Susan Samueli Center | Clinic/Center | 1202 Bristol St, Suite 200, Costa Mesa, CA 92626-8605 | 2015-10-21 |
| 1215341359 | Mark K. Nguyen Dental Business A Prof Corp | Dentist | 1202 Bristol St, 140, Costa Mesa, CA 92626-8605 | 2014-06-17 |
| 1881994838 | Robert Malmberg | Marriage & Family Therapist | 1202 Bristol St, Suite 130, Costa Mesa, CA 92626-8605 | 2010-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215536982 | Sergio Gutierrez | Behavior Technician | 3303 Harbor Blvd., Suite B8, Costa Mesa, CA 92626 | 2020-10-22 |
| 1780201848 | Kelly Chauvet | Behavior Technician | 1503 Nutmeg Place Suite 110, Costa Mesa, CA 92626 | 2020-07-06 |
| 1316564610 | Timo Rosa | Behavior Technician | 1503 Nutmeg Place, Suite 110, Costa Mesa, CA 92626 | 2020-07-02 |
| 1255966115 | Dalia A Sehweil | Behavior Technician | 1111 Baker, Costa Mesa, CA 92626 | 2020-03-11 |
| 1265071096 | Austin Stotelmyre | Behavior Technician | 1111 Baker St Costa Mesa 92626, Costa Mesa, CA 92626 | 2019-12-26 |
| 1396383022 | The Open Table | Community/Behavioral Health | 151 Kalmus Dr. Bldg C, Suite 100, Costa Mesa, CA 92626 | 2019-12-12 |
| 1851933550 | Jennifer Rivera | Behavior Technician | 1111 Baker St. Unit #a, Costa Mesa, CA 92626 | 2019-10-14 |
| 1962053595 | Peter Na | Behavior Technician | Behavior Functions 3303 Harbor Blvd, Ste B8, Costa Mesa, CA 92626 | 2019-09-25 |
| 1346897147 | Jennifer Lopez | Behavior Technician | 555 Alton Blvd Suite 150, Costa Mesa, CA 92626 | 2019-08-26 |
| 1679134084 | Danny Garcia Chiropractic, PC | Chiropractor | 1503 South Coast Drive, Suite 319, Costa Mesa, CA 92626 | 2019-06-26 |
| Find all providers in zip 92626 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104443506 | Coastal Mesa Corp. | Clinic/Center | 777 W 19th St Ste J, Costa Mesa, CA 92627-6131 | 2020-07-01 |
| 1770955593 | Susan Samueli Center | Clinic/Center | 1202 Bristol St, Suite 200, Costa Mesa, CA 92626-8605 | 2015-10-21 |
| 1588036289 | Susan Samueli Center | Clinic/Center | 1202 Bristol St, Suite 200, Costa Mesa, CA 92626-8605 | 2015-10-21 |
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| 1437767951 | Miro Health | Clinic/Center | 260 King St Unit 1505, San Francisco, CA 94107-6415 | 2020-07-21 |
| 1598383895 | Alacrity Patient Services, Inc. | Clinic/Center | 1002 N Hudson Ave Apt 1, Los Angeles, CA 90038-2595 | 2020-07-13 |
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| Find all providers with the same taxonomy | ||||
| City | COSTA MESA |
| Zip Code | 92626 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.