Healthcare Provider Details

I. General information

NPI: 1942129697
Provider Name (Legal Business Name): TODD MACAULEY DO A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 OLD NEWPORT BLVD STE 302
NEWPORT BEACH CA
92663-4244
US

IV. Provider business mailing address

471 OLD NEWPORT BLVD STE 302
NEWPORT BEACH CA
92663-4244
US

V. Phone/Fax

Practice location:
  • Phone: 949-415-4883
  • Fax: 949-625-2586
Mailing address:
  • Phone: 949-415-4883
  • Fax: 949-625-2586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TODD MACAULEY
Title or Position: CEO/CMO
Credential: DO
Phone: 949-415-4883