Provider Demographics
NPI:1881990752
Name:SWAN HEALTHCARE INCORPORATED
Entity type:Organization
Organization Name:SWAN HEALTHCARE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-910-1004
Mailing Address - Street 1:2618 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 800
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5437
Mailing Address - Country:US
Mailing Address - Phone:949-910-1004
Mailing Address - Fax:949-644-6022
Practice Address - Street 1:320 SUPERIOR AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2716
Practice Address - Country:US
Practice Address - Phone:949-910-1004
Practice Address - Fax:949-644-6022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA088378207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty