=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144300302
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GERALD MAGUIRE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2006
-----------------------------------------------------
Last Update Date | 12/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | GERALD A. MAGUIRE MD INC 31103 RANCHO VIEJO RD, SUITE D3046
-----------------------------------------------------
City | SAN JUAN CAPISTRACO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92675-1759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-212-8339
-----------------------------------------------------
Fax | 949-502-8887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | GERALD A. MAGUIRE MD INC 31103 RANCHO VIEJO RD, , SUITE D3046
-----------------------------------------------------
City | SAN JUAN CAPSTRANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92675-1759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-212-8339
-----------------------------------------------------
Fax | 949-502-8887
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | G75084
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------