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NPI Code Detail

MEDICARE: SOUTHERN CALIFORNIA ACUTE CARE PHYSICIANS

MEDICARE: SOUTHERN CALIFORNIA ACUTE CARE PHYSICIANS
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
1207P00000XEmergency Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4DC9564OTHERCARAILROAD MEDICARE
5CH8363OTHERCARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3ZZZ03049ZOTHERCABLUE SHIELD
6ZZZ01338ZOTHERCABLUE SHIELD
7ZZZ01337ZOTHERCABLUE SHIELD
8MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1881641462
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHERN CALIFORNIA ACUTE CARE PHYSICIANS
Provider Business Mailing Address
First Line : PO BOX 4419
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91365-4419
Country : US
Telephone Number : 866-266-6980
Fax Number : 818-587-2493
Provider Business Practice Location Address
First Line : 14662 NEWPORT AVE
Second Line :
City : TUSTIN
State : CA
Zip : 92780-6064
Country : US
Telephone Number : 714-669-2000
Fax Number : 818-587-2493
Authorized Official
Title or Position : PRESIDENT
Name : JOHN L GLAVINOVICH
Credential : MD
Telephone Number : 949-497-4225
Provider Enumeration Date : 05/28/2006
Last Update Date : 08/22/2020

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Directions to “SOUTHERN CALIFORNIA ACUTE CARE PHYSICIANS ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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