Fagan, Philip J.

Fagan, Philip J. is an individual health care provider with primary practice located at 14642 Newport Ave Ste 101 , Tustin CA 92780-6058. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / Emergency Medicine is his primary health care specialty. Fagan, Philip J. can be contacted via phone (714) 581-6470.

Contact Information

Primary practice address
14642 Newport Ave Ste 101 Tustin CA 92780-6058
Phone: (714) 581-6470
Fax: (714) 581-6492
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X C32505 California
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X C32505 California

Profile Details

NPI number 1255335154
LBN Legal business name Fagan, Philip J.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2005
Last updated Jan 23rd, 2024 - about 10 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255335154 NPPES
California Other 00C325050 BLUE SHIELD
California MEDICAID 00C325050 BLUE SHIELD
California Other 00C325050 BLUE SHIELD
California Other 930085818 BLUE SHIELD
California Other C32505 BLUE SHIELD

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