Healthcare Provider Details

I. General information

NPI: 1528164332
Provider Name (Legal Business Name): STEVEN D MACINA DO A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
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 NIGUEL CA
92677-1901
US

V. Phone/Fax

Practice location:
  • Phone: 714-375-5405
  • Fax: 714-375-5408
Mailing address:
  • Phone: 714-375-2077
  • Fax: 714-375-2078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEVEN D MACINA
Title or Position: OWNER
Credential: DO
Phone: 714-484-4900