Healthcare Provider Details

I. General information

NPI: 1982783395
Provider Name (Legal Business Name): OCMG, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26671 ALISO CREEK RD SUITE 205
ALISO VIEJO CA
92656-4809
US

IV. Provider business mailing address

26671 ALISO CREEK RD SUITE 101
ALISO VIEJO CA
92656-4809
US

V. Phone/Fax

Practice location:
  • Phone: 949-643-1132
  • Fax: 949-425-1204
Mailing address:
  • Phone: 949-643-1132
  • Fax: 949-425-1204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number20A6576
License Number StateCA

VIII. Authorized Official

Name: DR. ANGELA ROSE MILLER
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 949-643-1132