Healthcare Provider Details

I. General information

NPI: 1629153143
Provider Name (Legal Business Name): MISSION NEUROLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24502 PACIFIC PARK DR STE 102
ALISO VIEJO CA
92656-3033
US

IV. Provider business mailing address

27800 MEDICAL CENTER RD SUITE 263
MISSION VIEJO CA
92691-6447
US

V. Phone/Fax

Practice location:
  • Phone: 949-365-8877
  • Fax: 949-365-8878
Mailing address:
  • Phone: 949-365-8877
  • Fax: 949-365-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS LUDEMA
Title or Position: OWNER
Credential: MD
Phone: 949-365-8877