Healthcare Provider Details

I. General information

NPI: 1124130471
Provider Name (Legal Business Name): STEVEN MACINA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 NEWMAN AVE SUITE 200
HUNTINGTON BEACH CA
92647-7059
US

IV. Provider business mailing address

25421 SPINDLEWOOD
LAGUNA BEACH CA
92677
US

V. Phone/Fax

Practice location:
  • Phone: 714-375-5405
  • Fax: 714-375-5408
Mailing address:
  • Phone: 866-262-9066
  • Fax: 562-866-5730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A6625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: