| Amistad Medical Clinic Inc | |
|
201 S Broadway Santa Ana CA 92701-5633 | |
| (714) 571-4941 | |
| Not Available |
| Full Name | Amistad Medical Clinic Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 201 S Broadway, Santa Ana, California |
| Authorized Official Name and Position | Ajay G. Meka (PRESIDENT) |
| Authorized Official Contact | 7149795734 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Amistad Medical Clinic Inc 2740 S Bristol St Suite 208 Santa Ana CA 92704-6209 Ph: (714) 979-5734 | Amistad Medical Clinic Inc 201 S Broadway Santa Ana CA 92701-5633 Ph: (714) 571-4941 |
| NPI Number | 1932214657 |
|---|---|
| Provider Enumeration Date | 08/21/2006 |
| Last Update Date | 09/05/2019 |
| Medicare PECOS PAC ID | 0244129963 |
|---|---|
| Medicare Enrollment ID | O20040311001043 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932214657 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A37201 (California) | Secondary |
| 207R00000X | Internal Medicine | A39761 (California) | Primary |
| 207R00000X | Internal Medicine | A50217 (California) | Secondary |
| Provider Name | Ajay G Meka |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1063527976 PECOS PAC ID: 2062300163 Enrollment ID: I20040309001436 |
| Provider Name | Ranjit N Goonetilleke |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1033248083 PECOS PAC ID: 5395814982 Enrollment ID: I20080522000232 |
| Provider Name | Hemal Kadakia |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1588686042 PECOS PAC ID: 3476579624 Enrollment ID: I20080529000930 |
| Provider Name | David Graham |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639338601 PECOS PAC ID: 2062572118 Enrollment ID: I20081119000079 |
| Provider Name | Barry R Marfleet |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659397792 PECOS PAC ID: 9638241938 Enrollment ID: I20091103000122 |
| Provider Name | Meena K Meka |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1013338722 PECOS PAC ID: 8123245644 Enrollment ID: I20140806002750 |
| Provider Name | Tracy Huynh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275911075 PECOS PAC ID: 6002123759 Enrollment ID: I20150914002099 |
| Provider Name | Mabel E Carson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689074619 PECOS PAC ID: 5698091007 Enrollment ID: I20151210001548 |
| Provider Name | Maziar Nabavi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1770718967 PECOS PAC ID: 1951607696 Enrollment ID: I20160307002083 |
| Provider Name | Lawrence Craig Lerno |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851470983 PECOS PAC ID: 8628310448 Enrollment ID: I20190426002089 |
| Provider Name | Udoh O Obioha |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1154366946 PECOS PAC ID: 5193741163 Enrollment ID: I20190501001815 |
| Provider Name | Maria Saquic |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417510199 PECOS PAC ID: 0941536999 Enrollment ID: I20190729001954 |
| Provider Name | Mark Jefferson Rivera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1780045682 PECOS PAC ID: 8022348879 Enrollment ID: I20190923000676 |
| Provider Name | Jeany Leong Kung |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033765839 PECOS PAC ID: 4981014453 Enrollment ID: I20201112000883 |
| Provider Name | Noel Estioko |
|---|---|
| Provider Type | Practitioner - Allergy/immunology |
| Provider Identifiers | NPI Number: 1306890595 PECOS PAC ID: 4789666801 Enrollment ID: I20221004003752 |
| Provider Name | Salvador Basbas Villalon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538583901 PECOS PAC ID: 1254703127 Enrollment ID: I20230202003252 |
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