Provider Demographics
NPI:1982417101
Name:MEDEXA MEDICAL GROUP, CORPORATION
Entity type:Organization
Organization Name:MEDEXA MEDICAL GROUP, CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DILUVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-832-1055
Mailing Address - Street 1:2204 E 4TH ST STE 106
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3868
Mailing Address - Country:US
Mailing Address - Phone:949-832-1055
Mailing Address - Fax:
Practice Address - Street 1:2204 E 4TH ST STE 106
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3868
Practice Address - Country:US
Practice Address - Phone:949-832-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty