Provider Demographics
NPI:1760529598
Name:SOUTH COUNTY MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:SOUTH COUNTY MEDICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:STERNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-452-7799
Mailing Address - Street 1:24411 HEALTH CENTER DR
Mailing Address - Street 2:SUITE 460
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3651
Mailing Address - Country:US
Mailing Address - Phone:949-452-7799
Mailing Address - Fax:949-452-7797
Practice Address - Street 1:24411 HEALTH CENTER DR
Practice Address - Street 2:SUITE 460
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3651
Practice Address - Country:US
Practice Address - Phone:949-452-7799
Practice Address - Fax:949-452-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA55435P47Medicaid
CAG74818P47Medicaid
CA50060D947Medicaid
CAG58832P47Medicaid
CAG55436P47Medicaid
CAG55436P47Medicaid