Healthcare Provider Details

I. General information

NPI: 1972425585
Provider Name (Legal Business Name): MITOCHONDRIAL MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33872 AVENIDA CALITA
SAN JUAN CAPISTRANO CA
92675-4942
US

IV. Provider business mailing address

33959 DOHENY PARK RD # 1018
SAN JUAN CAPISTRANO CA
92675-4835
US

V. Phone/Fax

Practice location:
  • Phone: 949-226-8400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL HAGA
Title or Position: OWNER/PROVIDER
Credential: MD
Phone: 949-226-8400