| Laguna Tides Medical Group, Inc. | |
|
30131 Town Center Dr Suite 215 Laguna Niguel CA 92677-2034 | |
| (949) 499-1337 | |
| (949) 499-4962 |
| Full Name | Laguna Tides Medical Group, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 30131 Town Center Dr, Laguna Niguel, California |
| Authorized Official Name and Position | Robert V. Eller (PRESIDENT) |
| Authorized Official Contact | 9494991337 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Laguna Tides Medical Group, Inc. 30131 Town Center Dr Suite 215 Laguna Niguel CA 92677-2034 Ph: (949) 499-1337 | Laguna Tides Medical Group, Inc. 30131 Town Center Dr Suite 215 Laguna Niguel CA 92677-2034 Ph: (949) 499-1337 |
| NPI Number | 1811014319 |
|---|---|
| Provider Enumeration Date | 03/22/2007 |
| Last Update Date | 05/04/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811014319 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 20A9817 (California) | Primary |
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