Healthcare Provider Details

I. General information

NPI: 1093363848
Provider Name (Legal Business Name): ANTHONY MARTIN OCANA MD, CCFP, FASAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1968 S COAST HWY # 3664
LAGUNA BEACH CA
92651-3681
US

IV. Provider business mailing address

1968 S COAST HWY # 3664
LAGUNA BEACH CA
92651-3681
US

V. Phone/Fax

Practice location:
  • Phone: 604-803-8513
  • Fax:
Mailing address:
  • Phone: 604-803-8513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberC164730
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: