Provider Demographics
NPI:1861862385
Name:AQUAPHIRE INC
Entity Type:Organization
Organization Name:AQUAPHIRE INC
Other - Org Name:ORANGE COUNTY SKIN LAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:CATHLEEN
Authorized Official - Last Name:HURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-359-6400
Mailing Address - Street 1:31899 DEL OBISPO ST.
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675
Mailing Address - Country:US
Mailing Address - Phone:949-359-6400
Mailing Address - Fax:949-335-6529
Practice Address - Street 1:31899 DEL OBISPO ST
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3234
Practice Address - Country:US
Practice Address - Phone:949-359-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112182207ZD0900X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty