Provider Demographics
NPI:1841404142
Name:CADUCEUS PHYSICIANS MEDICAL GROUP
Entity Type:Organization
Organization Name:CADUCEUS PHYSICIANS MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSO MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-646-8000
Mailing Address - Street 1:18200 YORBA LINDA BLVD
Mailing Address - Street 2:STE #401
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-4056
Mailing Address - Country:US
Mailing Address - Phone:714-646-8008
Mailing Address - Fax:
Practice Address - Street 1:333 THALIA ST
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2713
Practice Address - Country:US
Practice Address - Phone:949-499-0577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CADUCEUS PHYSICIANS MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG43562DMedicare ID - Type Unspecified