MEDICARE: LAGUNA BEACH 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	261QU0200X	Urgent Care Clinic/Center	A95190	CA

General Provider Information

NPI Number	:	1710340559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAGUNA BEACH URGENT CARE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1075
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-5075
Country	:	US
Telephone Number	:	909-981-9800
Fax Number	:	909-946-3937

Provider Business Practice Location Address
First Line	:	32341 COAST HWY
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-6701
Country	:	US
Telephone Number	:	909-981-9800
Fax Number	:	909-946-3937

Authorized Official
Title or Position	:	CEO
Name	:	DR. MARC HOWARD SHOMER
Credential	:	MD
Telephone Number	:	909-981-9800

Provider Enumeration Date	:	03/30/2016
Last Update Date	:	02/02/2021

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