Provider Demographics
NPI:1891839155
Name:DANA NIGUEL INTERNAL MEDICINE GROUP
Entity Type:Organization
Organization Name:DANA NIGUEL INTERNAL MEDICINE GROUP
Other - Org Name:GREG A. BROWN, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-495-4305
Mailing Address - Street 1:655 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 124
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2809
Mailing Address - Country:US
Mailing Address - Phone:949-661-9657
Mailing Address - Fax:949-661-1352
Practice Address - Street 1:655 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 124
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2809
Practice Address - Country:US
Practice Address - Phone:949-661-9657
Practice Address - Fax:949-661-1352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85437Medicare UPIN
CAW10524Medicare ID - Type Unspecified