| South Coast Functional Medicine | |
|
187 Avenida La Pata San Clemente CA 92673-6307 | |
| (207) 337-0451 | |
| Not Available |
| Full Name | South Coast Functional Medicine |
|---|---|
| Speciality | General Practice |
| Location | 187 Avenida La Pata, San Clemente, California |
| Authorized Official Name and Position | Linda Long (CEO) |
| Authorized Official Contact | 2073370451 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Coast Functional Medicine Po Box 73236 San Clemente CA 92673-0107 Ph: (207) 337-0451 | South Coast Functional Medicine 187 Avenida La Pata San Clemente CA 92673-6307 Ph: (207) 337-0451 |
| NPI Number | 1740042670 |
|---|---|
| Provider Enumeration Date | 01/25/2024 |
| Last Update Date | 01/25/2024 |
| Certification Date | 01/25/2024 |
| Medicare PECOS PAC ID | 4789023318 |
|---|---|
| Medicare Enrollment ID | O20240416001970 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740042670 | NPI | - | NPPES |
| Provider Name | Linda Marie Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104094937 PECOS PAC ID: 4486708252 Enrollment ID: I20141016002010 |
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