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General NPI Number Information
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NPI Number | 1790990257
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Entity Type | Organization
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Legal Business Name | SOUTH COUNTY PHYSICIANS MEDICAL GROUP INC.
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 01/26/2015
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Provider Practice Location Address
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Address Line | 11180 WARNER AVE 165
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7501
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Country | US
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Telephone | 714-751-0995
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8907
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92728-8907
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Country | US
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Telephone | 714-546-7118
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | PAM CALDERON
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Credential |
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Telephone | 310-343-8884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A63326
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License Number State | CA
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