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General NPI Number Information
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NPI Number | 1932482239
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Entity Type | Organization
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Legal Business Name | SOCAL MEDICAL GROUP
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Dates
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Enumeration Date | 09/22/2011
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Last Update Date | 04/03/2019
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Provider Practice Location Address
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Address Line | 361 HOSPITAL RD STE 428
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3525
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Country | US
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Telephone | 949-722-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 361 HOSPITAL RD STE 428
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3525
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Country | US
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Telephone | 949-465-0770
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Fax | 949-220-9103
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Authorized Official
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Title or Position | CEO
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Name | JASON AMSTUTZ
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Credential | DO
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Telephone | 949-722-7070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | A108707
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License Number State | CA
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