=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720860059
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OSO PEDIATRICS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2023
-----------------------------------------------------
Last Update Date | 10/20/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24502 PACIFIC PARK DR STE 104
-----------------------------------------------------
City | ALISO VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92656-3033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-898-6220
-----------------------------------------------------
Fax | 949-898-6221
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24502 PACIFIC PARK DR STE 104
-----------------------------------------------------
City | ALISO VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92656-3033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-898-6220
-----------------------------------------------------
Fax | 949-898-6221
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SECRETARY
-----------------------------------------------------
Name | DR. ANNIQUE JUGANT MCGREGOR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 949-413-4719
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------