Provider Demographics
NPI:1730869454
Name:MISSION PREP HEALTHCARE
Entity type:Organization
Organization Name:MISSION PREP HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BILLING
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARBMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-424-9921
Mailing Address - Street 1:30310 RANCHO VIEJO RD
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1576
Mailing Address - Country:US
Mailing Address - Phone:424-328-5480
Mailing Address - Fax:949-579-2876
Practice Address - Street 1:430 SILVER SPUR RD STE 202
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VERDES
Practice Address - State:CA
Practice Address - Zip Code:90275-3571
Practice Address - Country:US
Practice Address - Phone:424-328-5480
Practice Address - Fax:949-579-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-18
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health