LAGUNA TIDES MEDICAL GROUP, INC. (NPI# 1811014319) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811014319 |
| Entity Type | Organization |
| Organization Name | LAGUNA TIDES MEDICAL GROUP, INC. |
| Practice Address |
30131 Town Center Dr Suite 215 Laguna Niguel CA 92677-2034 |
| Practice Telephone | 9494991337 |
| Practice Fax Number | 9494994962 |
| Mailing Telephone | 9494991337 |
| Mailing Fax Number | 9494994962 |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2010-05-04 |
| Authorized Official Name | ROBERT V. ELLER (PRESIDENT) |
| Authorized Official Telephone | 9494991337 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 20A9817 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
30131 TOWN CENTER DR SUITE 215 |
| City | LAGUNA NIGUEL |
| State | CA |
| Zip Code | 92677-2034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043219595 | Angela Calton | Specialist | 30131 Town Center Dr, Suite 250, Laguna Niguel, CA 92677-2034 | 2005-07-18 |
| 1356701965 | Dr Susan Pazak Psychological Services | Community/Behavioral Health | 30131 Town Center Dr, Suite 280, Laguna Niguel, CA 92677-2034 | 2016-02-25 |
| 1558747816 | Brandan Althof | Dentist | 30131 Town Center Dr, Laguna Niguel, CA 92677-2034 | 2015-08-09 |
| 1073916441 | Stacy Lavino | Marriage & Family Therapist | 30131 Town Center Dr, Suite #292, Laguna Niguel, CA 92677-2034 | 2014-09-30 |
| 1366858615 | Pediatric Neurology of Orange County, PC | Clinic/Center | 30131 Town Center Dr, Suite 245, Laguna Niguel, CA 92677-2034 | 2014-07-08 |
| 1174949408 | Norman F. Huefner Dmd A Prof Corp | Dentist | 30131 Town Center Dr, 160, Laguna Niguel, CA 92677-2034 | 2014-03-11 |
| 1508292491 | Teresa Geldmacher | Marriage & Family Therapist | 30131 Town Center Dr, #292, Laguna Niguel, CA 92677-2034 | 2013-09-24 |
| 1326482225 | Andrew R. Mcintosh, M.d. Inc. | Technician, Other | 30131 Town Center Dr, Suite 195, Laguna Niguel, CA 92677-2034 | 2013-04-22 |
| 1174861108 | Leisure Care Home Care Agency, Inc | Custodial Care Facility | 30131 Town Center Dr, Suite 205, Laguna Niguel, CA 92677-2034 | 2013-01-25 |
| 1861764854 | Melissa Przeklasa Auth Md Professional Corporation | Psychiatry & Neurology | 30131 Town Center Dr, 195, Laguna Niguel, CA 92677-2034 | 2012-02-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114566049 | Amber Kramer | Physical Therapist | 30100 Town Center Drive #yz, Laguna Niguel, CA 92677 | 2019-12-23 |
| 1811548340 | Morgan Peikar | Rehabilitation Hospital | 28441 Springfield Dr, Laguna Niguel, CA 92677 | 2019-09-25 |
| 1871056382 | Jacqueline Evamarie Serrano | Chiropractor | 28062 Forbes Road, Laguna Niguel, CA 92677 | 2019-04-11 |
| 1316408859 | Azadeh Ghafari | Social Worker | 30100 Town Center Dr # 179, Laguna Niguel, CA 92677 | 2019-03-27 |
| 1346741857 | Diana Wang | Physical Medicine & Rehabilitation | 30100 Town Center Drive Suite, Suite Yz, Laguna Niguel, CA 92677 | 2018-02-21 |
| 1750833554 | James H. Tran Dds, Dental Corp. | Dentist | 23876 Aliso Creek Road, Laguna Niguel, CA 92677 | 2016-10-27 |
| 1215486139 | Kevin Sun | Dentist | 49 Blue Horizon, Laguna Niguel, CA 92677 | 2016-10-04 |
| 1740637842 | Michael Dacosta | Dentist | 28862 Calle Vista, Laguna Niguel, CA 92677 | 2016-05-18 |
| 1235590373 | Adrian Gomez | Counselor | 24361 Nugget Falls Ln, Laguna Niguel, CA 92677 | 2016-03-17 |
| 1427455906 | Gracie Heart Home Health LLC | Home Health | 24318 El Pilar, Laguna Niguel, CA 92677 | 2014-11-26 |
| Find all providers in zip 92677 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972923241 | Robert Keith Ockner | Internal Medicine | 27759 Homestead Road, Laguna Niguel, CA 92677 | 2014-04-24 |
| 1821279225 | Susan Melissa Dindot | Internal Medicine | 30131 Town Center Dr Ste 140, Laguna Niguel, CA 92677-2010 | 2007-11-14 |
| 1164566477 | Peter Scott Jungwirth | Internal Medicine | 30111 Niguel Rd, Suite H, Laguna Niguel, CA 92677-2260 | 2007-02-19 |
| 1679681324 | Oso Niguel Medical Group | Internal Medicine | 27231 La Paz, #a, Laguna Niguel, CA 92677 | 2006-08-25 |
| 1104883610 | Vincent Rudolph Duda | Internal Medicine | 30281 Golden Lantern, Laguna Niguel, CA 92677-5979 | 2006-04-27 |
| 1598767170 | Sonja Stumme Krafcik | Internal Medicine | 25500 Rancho Niguel Rd, Suite 150, Laguna Niguel, CA 92677-7302 | 2005-08-12 |
| 1922300573 | Cheryl L Kellogg Md Inc | Internal Medicine | 30131 Town Center Dr, Suite 215, Laguna Niguel, CA 92677-2034 | 2010-12-01 |
| 1225282775 | Erin Elizabeth Parise | Internal Medicine | 30110 Crown Valley Pkwy, Suite 101, Laguna Niguel, CA 92677-2043 | 2008-11-11 |
| 1073763983 | Stuart C Seigel | Internal Medicine | 30281 Golden Lantern, Laguna Niguel, CA 92677-5979 | 2008-09-27 |
| 1215151071 | Amitpal Kohli | Internal Medicine | 30281 Golden Lantern, Laguna Niguel, CA 92677-5979 | 2007-04-12 |
| Find all providers in LAGUNA NIGUEL | ||||
| City | LAGUNA NIGUEL |
| Zip Code | 92677 |
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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.