Provider Demographics
NPI:1164517843
Name:SADDLEBACK RESPIRATORY MEDICAL GRP
Entity Type:Organization
Organization Name:SADDLEBACK RESPIRATORY MEDICAL GRP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNICOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-643-3345
Mailing Address - Street 1:PO BOX 7630
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-7630
Mailing Address - Country:US
Mailing Address - Phone:949-643-3345
Mailing Address - Fax:
Practice Address - Street 1:24451 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3689
Practice Address - Country:US
Practice Address - Phone:949-837-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G256840OtherBLUE SHIELD
00G256840OtherBLUE CROSS
CA00G256840Medicaid
CAZZZ53020YOtherBLUE CROSS/BLUE SHIELD
00G256840OtherBLUE SHIELD
DE7170Medicare PIN