Provider Demographics
NPI:1164553293
Name:MARK E ADLARD RANCHO SANTA MARGARITA FAMILY MEDICAL CENTER
Entity Type:Organization
Organization Name:MARK E ADLARD RANCHO SANTA MARGARITA FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-858-7001
Mailing Address - Street 1:22342 AVENIDA EMPRESA STE 195
Mailing Address - Street 2:MARK E ADLARD MD RANCHO SANTA MARGARITA FAMILY ME
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2140
Mailing Address - Country:US
Mailing Address - Phone:949-858-7001
Mailing Address - Fax:949-858-3826
Practice Address - Street 1:22342 AVENIDA EMPRESA STE 195
Practice Address - Street 2:MARK E ADLARD MD RANCHO SANTA MARGARITA FAMILY ME
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2140
Practice Address - Country:US
Practice Address - Phone:949-858-7001
Practice Address - Fax:949-858-3826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64159207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG64159OtherCA MEDICAL LICENSE #
CAZZZ35743ZOtherBLUE SHIELD PROVIDER #
CAG64159OtherLICENSE
CAZZZ35743ZOtherBLUE SHIELD PROVIDER #
CAE50593Medicare UPIN
CAG64159OtherLICENSE