BREAKWATER MEDICAL GROUP LLC (NPI# 1497019111) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497019111 |
| Entity Type | Organization |
| Organization Name | BREAKWATER MEDICAL GROUP LLC |
| Practice Address |
357 Victoria St Suite 2 Costa Mesa CA 92627-1931 |
| Practice Telephone | 9499031053 |
| Practice Fax Number | 8778208959 |
| Mailing Telephone | 9499031053 |
| Mailing Fax Number | 8778208959 |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2012-06-27 |
| Authorized Official Name | MATT LUCHINI (ACCOUNTS MANAGER) |
| Authorized Official Telephone | 9285334220 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | 05D2040895 | CA | Laboratories |
| Street Address |
357 VICTORIA ST SUITE 2 |
| City | COSTA MESA |
| State | CA |
| Zip Code | 92627-1931 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902407174 | Ryan Allen Merrell | Technician | 313 E. 17th Pl #l Costa Mesa, Costa Mesa, CA 92627 | 2020-11-04 |
| 1245703412 | Allure Transportation | Non-emergency Medical Transport (VAN) | 1835 Newport Blvd Ste 109 #110, Costa Mesa, CA 92627 | 2019-01-09 |
| 1750857686 | Living Success Center | Marriage & Family Therapist | 445 E. 17th Street, Suites D & E, Costa Mesa, CA 92627 | 2018-10-18 |
| 1790298909 | Akua Behavioral Health, Inc | Substance Abuse Rehabilitation Facility | 319-a University Drive, Costa Mesa, CA 92627 | 2017-11-09 |
| 1679086862 | Akua Behavioral Health, Inc | Substance Abuse Rehabilitation Facility | 319-b University Drive, Costa Mesa, CA 92627 | 2017-11-09 |
| 1245759018 | Surgical Assistant Associates | Clinic/Center | 186 E. 16th Street, Suite C, Costa Mesa, CA 92627 | 2017-09-13 |
| 1366962334 | Guadalupe A. Mejia Dental Corp. | Dentist | 700 W 19th St., Suite C, Costa Mesa, CA 92627 | 2017-06-21 |
| 1386189033 | Jian Yi Ye | Acupuncturist | 2488 Newport Blvd Ste B1, Costa Mesa, CA 92627 | 2017-01-04 |
| 1144764606 | Michele Marie Patton | Dental Hygienist | 2220 Fairview Rd., Costa Mesa, CA 92627 | 2016-12-18 |
| 1881148500 | Valerie Nguyen | Pharmacist | 1835 Newport Blvd # C, Costa Mesa, CA 92627 | 2016-08-10 |
| Find all providers in zip 92627 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962043083 | Synergy Diagnostics Laboratory, Inc. | Clinical Medical Laboratory | 3190 Airport Loop Dr Ste D1, Costa Mesa, CA 92626-3403 | 2019-09-30 |
| 1184195109 | Pacific Analytics LLC | Clinical Medical Laboratory | 3189 Airway Ave Ste C, Costa Mesa, CA 92626-4612 | 2018-12-17 |
| 1124554027 | Playa House, Inc. | Clinical Medical Laboratory | 2858 Drake Ave, Costa Mesa, CA 92626 | 2017-05-11 |
| 1871025916 | Integritox Laboratories, LLC | Clinical Medical Laboratory | 3151 Airway Ave Ste M1, Costa Mesa, CA 92626-4626 | 2017-03-29 |
| 1942656954 | Grace Shores Recovery, LLC | Clinical Medical Laboratory | 2554 Elden Ave, B103, Costa Mesa, CA 92627-5127 | 2016-05-09 |
| 1730570987 | Us Lab, Inc | Clinical Medical Laboratory | 3194 Airport Loop Dr, Ste. A, Costa Mesa, CA 92626-3405 | 2015-02-10 |
| 1477943496 | Clean & Sober Living Corp | Clinical Medical Laboratory | 260 Victoria St Apt C1, Costa Mesa, CA 92627-6002 | 2015-01-29 |
| 1659779643 | Element 7 Labs LLC | Clinical Medical Laboratory | 3189 Airway Ave, Suite D, Costa Mesa, CA 92626-4612 | 2014-12-08 |
| 1942617295 | Grace Shores Recovery, LLC | Clinical Medical Laboratory | 3170 Manistee Dr, Costa Mesa, CA 92626-3124 | 2014-07-18 |
| 1801162508 | Ghost Line Labs,inc. | Clinical Medical Laboratory | 137 Masters Circle, Costa Mesa, CA 92627 | 2012-03-27 |
| Find all providers in COSTA MESA | ||||
| City | COSTA MESA |
| Zip Code | 92627 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.