Provider Demographics
NPI:1336288745
Name:SADDLEBACK FAMILY MEDICINE
Entity Type:Organization
Organization Name:SADDLEBACK FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:IERARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-282-6500
Mailing Address - Street 1:24422 AVENIDA DE LA CARLOTA STE 272
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3648
Mailing Address - Country:US
Mailing Address - Phone:949-282-6500
Mailing Address - Fax:949-282-6501
Practice Address - Street 1:24422 AVENIDA DE LA CARLOTA STE 272
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3648
Practice Address - Country:US
Practice Address - Phone:949-282-6500
Practice Address - Fax:949-282-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG63246207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10891Medicare PIN
CAW10891Medicare PIN