Healthcare Provider Details

I. General information

NPI: 1861862385
Provider Name (Legal Business Name): AQUAPHIRE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31899 DEL OBISPO ST SUITE 130
SAN JUAN CAPISTRANO CA
92675-3234
US

IV. Provider business mailing address

31899 DEL OBISPO ST. SUITE 130
SAN JUAN CAPISTRANO CA
92675
US

V. Phone/Fax

Practice location:
  • Phone: 949-359-6400
  • Fax:
Mailing address:
  • Phone: 949-359-6400
  • Fax: 949-335-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA112182
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA112182
License Number StateCA

VIII. Authorized Official

Name: DR. MICHELLE CATHLEEN HURE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-359-6400