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General NPI Number Information
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NPI Number | 1255455978
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Entity Type | Organization
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Legal Business Name | LAGUNA BEACH OBGYN, INC.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/20/2019
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Provider Practice Location Address
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Address Line | 26800 CROWN VALLEY PKWY STE 460
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City | MISSION VIEJO
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State | CA
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Zip | 92691-8024
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Country | US
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Telephone | 949-499-2258
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Fax | 949-499-5697
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Provider Business Mailing Address
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Address Line | 26800 CROWN VALLEY PKWY STE 460
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City | MISSION VIEJO
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State | CA
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Zip | 92691-8024
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Country | US
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Telephone | 949-499-2258
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Fax | 949-499-5697
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Authorized Official
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Title or Position | OWNDER
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Name | KENNETH A JAMES
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Credential | MD
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Telephone | 949-499-2258
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | C52576
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License Number State | CA
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