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NPI Code Detail

MEDICARE: SADDLEBACK MEDICAL GROUP, INC

MEDICARE: SADDLEBACK MEDICAL GROUP, 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
1207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1124502265
Entity Type Code : Organization
Provider Name (Legal Business Name) : SADDLEBACK MEDICAL GROUP, INC
Provider Business Mailing Address
First Line : 24221 CALLE DE LA LOUISA STE 400
Second Line :
City : LAGUNA HILLS
State : CA
Zip : 92653-7632
Country : US
Telephone Number : 949-465-8155
Fax Number : 949-465-8159
Provider Business Practice Location Address
First Line : 24331 EL TORO RD STE 330
Second Line :
City : LAGUNA WOODS
State : CA
Zip : 92637-2754
Country : US
Telephone Number : 949-716-0833
Fax Number : 949-581-0694
Authorized Official
Title or Position : DIRECTOR/OFFICER
Name : DR. BENJAMIN M WEINBERG
Credential : M.D.
Telephone Number : 949-465-8155
Provider Enumeration Date : 09/24/2018
Last Update Date : 09/24/2018

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