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General NPI Number Information
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NPI Number | 1437794229
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Entity Type | Organization
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Legal Business Name | ORANGE COUNTY FUNCTIONAL & INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 11/15/2019
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 25431 CABOT RD STE 207
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-5527
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Country | US
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Telephone | 949-303-6391
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Fax |
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Provider Business Mailing Address
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Address Line | 53 VIA MARBRISA
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-5685
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Country | US
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Telephone | 949-303-6391
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PEARL ZIMMERMAN
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Credential | MD
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Telephone | 949-303-6391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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