Mesa Advantage Medical Group

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

MESA ADVANTAGE MEDICAL GROUP

Practice address

2295 Huntington Dr # D
San Marino, CA 91108-2640

Phone

(626) 656-2370

Fax

(626) 248-9060

NPI assigned

Aug 5, 2016

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Lan Nhu Bich Phan

Title

Ceo

Phone

(818) 399-8996

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1470355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1578017778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2295 HUNTINGTON DR # D",
            "city": "SAN MARINO",
            "state": "CA",
            "postal_code": "911082640",
            "telephone_number": "626-656-2370",
            "fax_number": "626-248-9060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2295 HUNTINGTON DR # D",
            "city": "SAN MARINO",
            "state": "CA",
            "postal_code": "911082640",
            "telephone_number": "626-656-2370",
            "fax_number": "626-248-9060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MESA ADVANTAGE MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PHAN",
        "authorized_official_first_name": "LAN",
        "authorized_official_middle_name": "NHU BICH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-399-8996",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "CA",
            "license": "A",
            "primary": false
        },
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Hortenstine McDowell, PA-C
• Brent McMahon, PT
• Rochelle Medici, PHD
• Medipro Medical Group Inc
• Rita Fogata Mejia, RDN
• Mike Nicholas Milinkovic, CHIROPRACTOR
• Robert M. Miller, PH.D.
• Karen I Minero, L.C.S.W.
• Mitchell C Latter M D Inc a Prof Corp
• Robert Joseph Monn, MA, AMFT

• Exclusive Provider Organization in San Marino, CA
• Providers in San Marino, CA by specialty
• Exclusive Provider Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.