Provider Demographics
NPI:1720434681
Name:PREVENTIVE HEALTHCARE MEDICAL CENTERS
Entity Type:Organization
Organization Name:PREVENTIVE HEALTHCARE MEDICAL CENTERS
Other - Org Name:HOAG EXECUTIVE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:LINDBERG
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:949-566-8414
Mailing Address - Street 1:2100 MAIN ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6237
Mailing Address - Country:US
Mailing Address - Phone:949-566-8414
Mailing Address - Fax:949-872-2370
Practice Address - Street 1:500 SUPERIOR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3657
Practice Address - Country:US
Practice Address - Phone:949-566-8414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG059887207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty