Provider Demographics
NPI:1619032208
Name:SANTA MARGARITA MEDICAL GROUP
Entity Type:Organization
Organization Name:SANTA MARGARITA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-459-8127
Mailing Address - Street 1:22431 B160 ANTONIO PKWY #484
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688
Mailing Address - Country:US
Mailing Address - Phone:949-459-8127
Mailing Address - Fax:949-459-7649
Practice Address - Street 1:22361 ANTONIO PKWY #E130
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688
Practice Address - Country:US
Practice Address - Phone:949-459-8127
Practice Address - Fax:949-459-7649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70008174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEIN