PERFORMANCE HEALTH MEDICAL GROUP (NPI# 1750622577) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750622577 |
| Entity Type | Organization |
| Organization Name | PERFORMANCE HEALTH MEDICAL GROUP |
| Other Organization Name | PERFORMANCE HEALTH MEDICAL GROUP |
| Practice Address |
25431 Cabot Rd Suite 118 Laguna Hills CA 92653-5518 |
| Mailing Address |
5626 Oberlin Dr Suite 110 San Diego CA 92121-1705 |
| Practice Telephone | 9492874559 |
| Enumeration Date | 2013-03-04 |
| Last Update Date | 2013-03-04 |
| Authorized Official Name | KENNY HEINE (VP OF OPERATIONS) |
| Authorized Official Telephone | 8589641506 |
| Is Organization Subpart | Y |
| Parent Organization Name | MEDVANTX, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332900000X | Non-Pharmacy Dispensing Site | G45164 | CA | Suppliers |
| Other Name | Type Code |
|---|---|
| Performance Health Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023511045 | Performance Health Medical Group | Non-Pharmacy Dispensing Site | 25431 Cabot Road Suite 118, Laguna Hills, CA 92653 | 2018-03-15 |
| 1174660161 | Performance Health Medical Group | Family Medicine | 13252 Garden Grove Blvd, Suite 112, Garden Grove, CA 92843-2204 | 2007-01-31 |
| 1922145911 | Performance Health Medical Group | Chiropractor | 21707 Hawthorne Blvd, Ste 201, Torrance, CA 90503 | 2007-01-31 |
| Street Address |
25431 CABOT RD SUITE 118 |
| City | LAGUNA HILLS |
| State | CA |
| Zip Code | 92653-5518 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093896862 | Performance Health Medical Group, Inc | Chiropractor | 25431 Cabot Rd, Suite 118, Laguna Hills, CA 92653-5518 | 2006-10-18 |
| 1356710438 | Paul John Licata Md | Clinic/Center | 25431 Cabot Rd, Ste 115, Laguna Hills, CA 92653-5518 | 2015-09-18 |
| 1265773048 | Ashlee Denaro | Specialist | 25431 Cabot Rd, Suite 118, Laguna Hills, CA 92653-5518 | 2013-03-04 |
| 1043534134 | Alternative & Complementary Medicine, Inc. | Clinical Medical Laboratory | 25431 Cabot Rd, Suite 202a, Laguna Hills, CA 92653-5518 | 2010-03-18 |
| 1710016456 | Valerie Want | Psychologist | 25431 Cabot Rd, Ste. 111, Laguna Hills, CA 92653-5518 | 2007-03-05 |
| 1306975040 | Haig Musurlian | Psychologist | 25431 Cabot Rd, Ste. 111, Laguna Hills, CA 92653-5518 | 2007-03-05 |
| 1225175003 | Amir Shahab Mohseni | Dentist | 25431 Cabot Rd, #205, Laguna Hills, CA 92653-5518 | 2007-01-31 |
| 1316090616 | Edward John Reynolds | Chiropractor | 25431 Cabot Rd, #110, Laguna Hills, CA 92653-5518 | 2007-01-19 |
| 1346393659 | John Bruce Dorsey | Orthopaedic Surgery | 25431 Cabot Rd, #110, Laguna Hills, CA 92653-5518 | 2007-01-19 |
| 1407908866 | Joanne G. Pagal | Family Medicine | 25431 Cabot Rd, Suite 115, Laguna Hills, CA 92653-5518 | 2007-01-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932708476 | Nikkie Veyseh | Behavior Technician | 26921 Falling Leaf Dr., Laguna Hills, CA 92653 | 2020-10-24 |
| 1609480425 | Steve Ceja | Behavior Technician | 25201 Paseo De Alicia Suite 110, Laguna Hills, CA 92653 | 2020-08-31 |
| 1467006882 | Kristina Alexa Puno Morales | Dietitian, Registered | 24552 Health Center Drive, Laguna Hills, CA 92653 | 2019-07-25 |
| 1164929626 | Shoreline Consulting Services, Inc. | Clinic/Center | 23010 Lake Forest Drive, Suite B, Laguna Hills, CA 92653 | 2018-04-11 |
| 1023511045 | Performance Health Medical Group | Non-Pharmacy Dispensing Site | 25431 Cabot Road Suite 118, Laguna Hills, CA 92653 | 2018-03-15 |
| 1831613850 | Stephani A Berg | Physical Medicine & Rehabilitation | 24422 Avenida De La Carlota Suite 190, Laguna Hills, CA 92653 | 2017-08-01 |
| 1497299945 | Stephanie Lyle | Nurse Practitioner | 24221 Calle De Louisa, Suite 400, Laguna Hills, CA 92653 | 2016-12-16 |
| 1053776278 | Meillanny Gladness | Counselor | 23151 Verdugo Dr Ste 203, Laguna Hills, CA 92653 | 2015-12-16 |
| 1912383183 | Pmdca, LLC | Clinical Medical Laboratory | 23297 S Pointe Dr Ste 100, Laguna Hills, CA 92653 | 2015-08-10 |
| 1821486630 | 4mpw, Inc. | Home Health | 23232 Peralta Drive 216, Laguan Hills, CA 92653 | 2014-12-31 |
| Find all providers in zip 92653 | ||||
| Taxonomy Code | 332900000X |
| Grouping | Suppliers |
| Classification | Non-Pharmacy Dispensing Site |
| A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.) |
| Notes: Source: Developed by National Council for Prescription Drug Programs (NCPDP), National Home Infusion Association (NHIA), and Pharmacist Services Technical Advisory Coalition (PSTAC) [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023511045 | Performance Health Medical Group | Non-Pharmacy Dispensing Site | 25431 Cabot Road Suite 118, Laguna Hills, CA 92653 | 2018-03-15 |
| 1174606404 | Suhail I Hawatt Md | Non-Pharmacy Dispensing Site | 23961 Calle De La Magdalena Ste 517, Laguna Hills, CA 92653-7628 | 2006-10-23 |
| 1780744755 | Roger Tran Md | Non-Pharmacy Dispensing Site | 23521 Paseo De Valencia, Suite 311, Laguna Hills, CA 92653-3144 | 2006-12-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982225496 | Artius Dermatology Associates PC | Non-Pharmacy Dispensing Site | 5757 Pacific Ave Ste 228, Stockton, CA 95207-5159 | 2020-05-06 |
| 1285268391 | Artius Dermatology Associates PC | Non-Pharmacy Dispensing Site | 1337 S Lovers Ln Ste D, Visalia, CA 93292-5249 | 2020-02-27 |
| 1790327732 | Triumph Specialties LLC | Non-Pharmacy Dispensing Site | 11100 Sepulveda Blvd # 8-519, Mission Hills, CA 91345-1131 | 2019-10-10 |
| 1487210365 | Artius Dermatology Associates P.C. | Non-Pharmacy Dispensing Site | 325 Mall Dr Ste 111, Hanford, CA 93230-5950 | 2019-05-15 |
| 1376030080 | Jane F Kardashian Md Inc | Non-Pharmacy Dispensing Site | 6769 N Fresno, Fresno, CA 93710 | 2018-04-18 |
| 1043719206 | Southern California Orthopedic Institute L.p | Non-Pharmacy Dispensing Site | 4100 Empire Dr Ste 120, Bakersfield, CA 93309-0408 | 2018-02-02 |
| 1174032353 | Golden Gate Urology, Inc. | Non-Pharmacy Dispensing Site | 139 Townsend St Ste 100, San Francisco, CA 94107-1946 | 2017-09-20 |
| 1215462080 | Mas Management Group, Inc. | Non-Pharmacy Dispensing Site | 28446 Constellation Rd, Valencia, CA 91355-5081 | 2017-04-28 |
| 1730624719 | St. John's Well Child and Family Center Inc | Non-Pharmacy Dispensing Site | 326 W 23rd St, Los Angeles, CA 90007-2612 | 2016-12-29 |
| 1235680802 | Wizard of Eyes Optical | Non-Pharmacy Dispensing Site | 17205 Ventura Blvd Unit A, Encino, CA 91316-4007 | 2016-10-19 |
| Find all providers with the same taxonomy | ||||
| City | LAGUNA HILLS |
| Zip Code | 92653 |
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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.