Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mesa Advantage Medical Group

Organization Exclusive Provider Organization · NPI 1578017778

Mesa Advantage Medical Group is an Exclusive Provider Organization in San Marino, California. Licensed in California. Registered with an NPI since 2016.

Licensed in
CA
In the registry since
2016
Specialties on file
2

Practice location Address checks out

2295 Huntington Dr # D
San Marino, CA 91108-2640
Phone: (626) 656-2370
Fax: (626) 248-9060
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Exclusive Provider Organization (primary) Taxonomy 302F00000X
Exclusive Provider Organization Taxonomy 302F00000X · Licence A (CA)

Record details

NPI number1578017778
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lan Phan — Ceo · (818) 399-8996
NPI enumeratedAugust 5, 2016
Last updated in NPPESJuly 21, 2022
Mailing address2295 Huntington Dr # D, San Marino, CA 91108-2640

Other providers in San Marino