MEDICARE: LAGUNA-DANA URGENT CARE INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	G34265	CA
2	261QX0100X	Occupational Medicine Clinic/Center	G34265	CA
3	261QU0200X	Urgent Care Clinic/Center	G034265	CA

General Provider Information

NPI Number	:	1063693653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAGUNA-DANA URGENT CARE INC

Provider Business Mailing Address
First Line	:	18231 IRVINE BLVD
Second Line	:	STE 204
City	:	TUSTIN
State	:	CA
Zip	:	92780-3432
Country	:	US
Telephone Number	:	714-389-5700
Fax Number	:	714-389-6973

Provider Business Practice Location Address
First Line	:	24060 CAMINO DEL AVION
Second Line	:	SUITE A
City	:	MONARCH BEACH
State	:	CA
Zip	:	92629-4006
Country	:	US
Telephone Number	:	949-248-8900
Fax Number	:	949-248-8901

Authorized Official
Title or Position	:	CEO
Name	:	DR. ROBERT CRAIG AMSTER
Credential	:	MD
Telephone Number	:	714-389-5700

Provider Enumeration Date	:	11/24/2007
Last Update Date	:	05/16/2011

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