Healthcare Provider Details

I. General information

NPI: 1093945412
Provider Name (Legal Business Name): MISSION HOSPITAL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2009
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31872 COAST HWY
LAGUNA BEACH CA
92651-6773
US

IV. Provider business mailing address

31872 COAST HWY
LAGUNA BEACH CA
92651-6773
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-1400
  • Fax:
Mailing address:
  • Phone: 949-364-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number060000146
License Number StateCA

VIII. Authorized Official

Name: DONALD W ANDERSON JR.
Title or Position: ASSISTANT SECRETARY ENROLLMENTS
Credential:
Phone: 425-358-9786