Healthcare Provider Details

I. General information

NPI: 1427159383
Provider Name (Legal Business Name): CONTEMPORARY HEALTHCARE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3553 CAMINO MIRA COSTA #A
SAN CLEMENTE CA
92672-3512
US

IV. Provider business mailing address

3553 CAMINO MIRA COSTA #A
SAN CLEMENTE CA
92672-3512
US

V. Phone/Fax

Practice location:
  • Phone: 949-661-6001
  • Fax: 949-661-8353
Mailing address:
  • Phone: 949-661-6001
  • Fax: 949-661-8353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A5020
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberG26491 MCGEE
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberG25398 ZACHARY
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID R. ZACHARY
Title or Position: SECRETARY
Credential: M.D.
Phone: 949-661-6001