Provider Demographics
NPI:1164523122
Name:ALLERGY & ASTHMA ASSOCIATES OF SOUTHERN CALIF INC
Entity Type:Organization
Organization Name:ALLERGY & ASTHMA ASSOCIATES OF SOUTHERN CALIF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOTTILE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-364-2900
Mailing Address - Street 1:27800 MEDICAL CENTER RD
Mailing Address - Street 2:SUITE 244
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6410
Mailing Address - Country:US
Mailing Address - Phone:949-364-2900
Mailing Address - Fax:949-365-0117
Practice Address - Street 1:27800 MEDICAL CENTER RD
Practice Address - Street 2:SUITE 244
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6410
Practice Address - Country:US
Practice Address - Phone:949-364-2900
Practice Address - Fax:949-365-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW6384Medicare ID - Type Unspecified