Provider Demographics
NPI:1528294642
Name:JOHN J. URSINO, MD INC
Entity type:Organization
Organization Name:JOHN J. URSINO, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRCHER
Authorized Official - Suffix:
Authorized Official - Credentials:CONTRACT
Authorized Official - Phone:951-683-2324
Mailing Address - Street 1:751 S WEIR CANYON RD
Mailing Address - Street 2:PMB 482
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1962
Mailing Address - Country:US
Mailing Address - Phone:714-547-3900
Mailing Address - Fax:714-547-3903
Practice Address - Street 1:1401 N TUSTIN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8644
Practice Address - Country:US
Practice Address - Phone:714-547-3900
Practice Address - Fax:714-547-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA407392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA40739OtherLICENSE NUMBER