Healthcare Provider Details

I. General information

NPI: 1215763164
Provider Name (Legal Business Name): CARE360 MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25044 PEACHLAND AVE STE 104
SANTA CLARITA CA
91321-5747
US

IV. Provider business mailing address

25044 PEACHLAND AVE STE 110
SANTA CLARITA CA
91321-5730
US

V. Phone/Fax

Practice location:
  • Phone: 951-717-8787
  • Fax: 951-717-8758
Mailing address:
  • Phone: 844-960-2673
  • Fax: 818-356-4380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES MACIEL
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 714-458-4617