Provider Demographics
NPI:1447283437
Name:MY WAY MANAGEMENT SERVICES, LLC
Entity type:Organization
Organization Name:MY WAY MANAGEMENT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:BRUNDIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-296-6377
Mailing Address - Street 1:2913 EL CAMINO REAL # 344
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92782-8909
Mailing Address - Country:US
Mailing Address - Phone:714-296-6377
Mailing Address - Fax:
Practice Address - Street 1:2913 EL CAMINO REAL # 344
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-8909
Practice Address - Country:US
Practice Address - Phone:714-296-6377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78673174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty