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General NPI Number Information
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NPI Number | 1932131653
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Entity Type | Organization
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Legal Business Name | PACIFIC CREST MEDICAL GROUP INC
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 02/06/2012
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Provider Practice Location Address
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Address Line | 34052 LA PLZ SUITE 101
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City | DANA POINT
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State | CA
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Zip | 92629-2587
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Country | US
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Telephone | 949-388-4316
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Fax | 949-388-4319
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Provider Business Mailing Address
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Address Line | PO BOX 3630
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City | DANA POINT
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State | CA
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Zip | 92629-8630
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Country | US
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Telephone | 949-388-4316
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Fax | 949-388-4319
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Authorized Official
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Title or Position | CONTROLLER
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Name | LESLEY ROBERTS
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Credential |
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Telephone | 949-388-4316
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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 |
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License Number State |
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