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Organization
PERFORMANCE HEALTH MEDICAL GROUP, INC
Active
Organization
PERFORMANCE HEALTH MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRIAN D CARRICO D.C. (PRESIDENT)
(949) 362-8877
Entity
Organization
Contact information
Practice address
25431 CABOT RD, SUITE 118, LAGUNA HILLS, CA 92653-5518
(949) 362-8877
(949) 598-8042
Mailing address
25431 CABOT RD, SUITE 118, LAGUNA HILLS, CA 92653-5518
(949) 362-8877
(949) 598-8042
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
363AM0700X
Medical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
120115601
GROUP
CA
Enumeration date
10/18/2006
Last updated
03/25/2009
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