Ocean Breeze Medical Group, INC.
Family Medicine in San Clemente, CA. Organization (NPI-2).
NPI number1386790400
StatusActive
Last updated in NPPESDec 13, 2010
Details
- NPI
- 1386790400
- Entity type
- Organization (NPI-2)
- Legal business name
- Ocean Breeze Medical Group, INC.
- Organization subpart
- No
- Enumeration date
- Jan 25, 2007
- Last updated
- Dec 13, 2010
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | A065157 | CA | Yes |
Practice location
150 Avenida Cabrillo Ste ASan Clemente, CA 92672-5595
Phone 949-369-6993
Mailing address
150 Avenida Cabrillo Ste ASan Clemente, CA 92672-5595
Phone 949-369-6993
Authorized official
Ricardo Davalos
Owner
9493696993
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