Organization · NPI-2

Bristol Park Medical Group, INC

Family Medicine · Mission Viejo, CA

NPI number1063469229

StatusActive

Last updated in NPPESOct 15, 2008

Details

NPI: 1063469229
Entity type: Organization (NPI-2)
Legal business name: Bristol Park Medical Group, INC
Organization subpart: No
Enumeration date: May 31, 2006
Last updated: Oct 15, 2008

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
207Q00000X	Family Medicine	–	–	Yes
207R00000X	Internal Medicine	–	–
208000000X	Pediatrics	–	–
332B00000X	Durable Medical Equipment & Medical Supplies	–	–

Practice location

26991 Crown Valley Pkwy
Mission Viejo, CA 92691-6528

Phone 949-582-2002 · Fax 949-367-5200

Mailing address

2742 Dow Ave
Tustin, CA 92780-7242

Phone 714-665-1600

Authorized official

Mark D Schafer
Medical Director
7146651661

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