NPIMap

Organization Active NPI

San Martin Deporres Medical Group

  • Geriatric Medicine (Family Medicine) Physician
  • Santa Ana, CA
National Provider Identifier
1861513525
Registry record updated Mar 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
A60865 Issued in CA
Legal business name
SAN MARTIN DEPORRES MEDICAL GROUP
Practice address
1701 E McFadden Ave
Unit D
Santa Ana, CA 92705-4647
Phone
(714) 953-6430
NPI assigned
Apr 2, 2007
Last updated
Mar 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2011

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

Authorized official

Name
Mr. Jacob N Flores, M.D.
Title
Owner
Phone
(714) 953-6430

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X W11619 CA
Geriatric Medicine (Family Medicine) Physician 207QG0300X A60865 CA Primary

Addresses

Primary practice location

1701 E McFadden Ave
Unit D
Santa Ana, CA 92705-4647

Mailing address

1701 E McFadden Ave
Unit D
Santa Ana, CA 92705-4647
Phone (714) 953-6430

National Provider Directory

National Provider Directory

Locations

1701 E McFadden Ave
Ste D
Santa Ana, CA 92705
Phone (714) 653-6430

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1175472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299628800000",
    "number": "1861513525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1701 E MCFADDEN AVE",
            "address_2": "UNIT D",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927054647",
            "telephone_number": "714-953-6430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 E MCFADDEN AVE",
            "address_2": "UNIT D",
            "city": "SANTA ANA",
            "state": "CA",
            "postal_code": "927054647",
            "telephone_number": "714-953-6430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN MARTIN DEPORRES MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-02",
        "last_updated": "2011-03-09",
        "status": "A",
        "authorized_official_last_name": "FLORES",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-953-6430",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "W11619",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "CA",
            "license": "A60865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Ana, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2011; 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.