Provider Demographics
NPI:1871649491
Name:MCL HEALTH MANAGEMENT
Entity Type:Organization
Organization Name:MCL HEALTH MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-547-4070
Mailing Address - Street 1:P.O. BOX 10340
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92711-0340
Mailing Address - Country:US
Mailing Address - Phone:714-547-4070
Mailing Address - Fax:714-751-4619
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:STE. 507
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-547-4070
Practice Address - Fax:714-751-4619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33713174400000X
CAPSY4309174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty