MEDICARE: ACN GROUP OF CALIFORNIA, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1467513218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACN GROUP OF CALIFORNIA, INC

Provider Business Mailing Address
First Line	:	3111 CAMINO DEL RIO N
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5720
Country	:	US
Telephone Number	:	619-641-7100
Fax Number	:	619-641-7185

Provider Business Practice Location Address
First Line	:	3111 CAMINO DEL RIO N
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5720
Country	:	US
Telephone Number	:	619-641-7100
Fax Number	:	619-641-7185

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEPHEN CASTRO
Credential	:
Telephone Number	:	619-641-6706

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	12/28/2011

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