Healthcare Provider Details

I. General information

NPI: 1154061117
Provider Name (Legal Business Name): ERICA GEORGE BAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W AVENIDA VISTA HERMOSA UNIT K
SAN CLEMENTE CA
92672-7720
US

IV. Provider business mailing address

26800 CROWN VALLEY PKWY STE 435
MISSION VIEJO CA
92691-8023
US

V. Phone/Fax

Practice location:
  • Phone: 949-542-8007
  • Fax: 949-542-7436
Mailing address:
  • Phone: 949-347-3641
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA191480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: