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Organization
CADUCEUS PHYSICIANS MEDICAL GROUP
Active
Organization
CADUCEUS PHYSICIANS MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGG DENICOLA MD (CEO)
(714) 646-8000
Entity
Organization
Contact information
Practice address
18200 YORBA LINDA BLVD STE 250, YORBA LINDA, CA 92886-4044
(714) 646-8000
(714) 572-2562
Mailing address
18200 YORBA LINDA BLVD STE 111, YORBA LINDA, CA 92886-4043
(714) 646-8000
(714) 572-2562
Taxonomy
Speciality
Code
Description
License number
State
133N00000X
Nutritionist
—
CA
207Q00000X
Family Medicine Physician
Primary
—
CA
207R00000X
Internal Medicine Physician
—
CA
207T00000X
Neurological Surgery Physician
—
CA
207V00000X
Obstetrics & Gynecology Physician
—
CA
207X00000X
Orthopaedic Surgery Physician
—
CA
207Y00000X
Otolaryngology Physician
—
CA
208000000X
Pediatrics Physician
—
CA
208800000X
Urology Physician
—
CA
213E00000X
Podiatrist
—
CA
225100000X
Physical Therapist
—
CA
225700000X
Massage Therapist
—
CA
247100000X
Radiologic Technologist
—
CA
261QU0200X
Urgent Care Clinic/Center
—
—
363AM0700X
Medical Physician Assistant
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0938185
CLIA
CA
05
—
GR0084863
—
CA
01
—
ZZZ58296Z
BLUE SHIELD
CA
Enumeration date
05/30/2006
Last updated
04/27/2023
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