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1497702724

NPI Code Detail

MEDICARE: CADUCEUS PHYSICIANS MEDICAL GROUP

MEDICARE: CADUCEUS PHYSICIANS MEDICAL GROUP

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	133N00000X	Nutritionist		CA
2	207R00000X	Internal Medicine Physician		CA
3	207T00000X	Neurological Surgery Physician		CA
4	207V00000X	Obstetrics & Gynecology Physician		CA
5	207X00000X	Orthopaedic Surgery Physician		CA
6	207Y00000X	Otolaryngology Physician		CA
7	208000000X	Pediatrics Physician		CA
8	208800000X	Urology Physician		CA
9	213E00000X	Podiatrist		CA
10	225100000X	Physical Therapist		CA
11	225700000X	Massage Therapist		CA
12	247100000X	Radiologic Technologist		CA
13	261QU0200X	Urgent Care Clinic/Center
14	363AM0700X	Medical Physician Assistant		CA
15	207Q00000X	Family Medicine Physician		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05D0938185	OTHER	CA	CLIA
2	ZZZ58296Z	OTHER	CA	BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497702724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CADUCEUS PHYSICIANS MEDICAL GROUP

Provider Business Mailing Address
First Line	:	18200 YORBA LINDA BLVD STE 111
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-4043
Country	:	US
Telephone Number	:	714-646-8000
Fax Number	:	714-572-2562

Provider Business Practice Location Address
First Line	:	18200 YORBA LINDA BLVD STE 250
Second Line	:
City	:	YORBA LINDA
State	:	CA
Zip	:	92886-4044
Country	:	US
Telephone Number	:	714-646-8000
Fax Number	:	714-572-2562

Authorized Official
Title or Position	:	CEO
Name	:	GREGG DENICOLA
Credential	:	MD
Telephone Number	:	714-646-8000

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	04/27/2023

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1043908866 — HADEIAH MELODY HOSSEINI PA-C
Practice Location Address:

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Directions to “CADUCEUS PHYSICIANS MEDICAL GROUP ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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