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General NPI Number Information
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NPI Number | 1407860844
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Entity Type | Organization
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Legal Business Name | SOUTH ORANGE COUNTY SURGICAL MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 24411 HEALTH CENTER DR SUITE 350
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3651
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Country | US
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Telephone | 949-457-7900
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Fax | 949-583-9148
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Provider Business Mailing Address
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Address Line | 24411 HEALTH CENTER DR STE 350
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3687
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Country | US
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Telephone | 949-457-7900
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Fax | 949-583-9148
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Authorized Official
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Title or Position | CEO
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Name | DR. WILLIAM CAMPBELL WALLACE
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Credential | MD
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Telephone | 949-457-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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