Provider Demographics
NPI:1932482239
Name:SOCAL MEDICAL GROUP
Entity Type:Organization
Organization Name:SOCAL MEDICAL GROUP
Other - Org Name:LINK MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:AMSTUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-722-7070
Mailing Address - Street 1:361 HOSPITAL RD STE 428
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3525
Mailing Address - Country:US
Mailing Address - Phone:949-465-0770
Mailing Address - Fax:949-220-9103
Practice Address - Street 1:361 HOSPITAL RD STE 428
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3525
Practice Address - Country:US
Practice Address - Phone:949-722-7070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
CAA108707208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1043277866OtherDON ROURKE
CA1053729293OtherKENNETH DOBBS
CA1184929408OtherMICHAEL HOLLIS
CA1306016043OtherFRANK ACUNIA
CA1184083057OtherANDREW ADAMS