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Organization
OC LATINO MEDICAL GROUP INC
Active
Organization
OC LATINO MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GASTON F CILLIANI MD (MD)
(949) 574-2121
Entity
Organization
Contact information
Practice address
767 W 19TH STREET, 101, COSTA MESA, CA 92627
(949) 574-2121
(949) 574-9358
Mailing address
767 W 19TH STREET, 101, COSTA MESA, CA 92627
(949) 574-2121
(949) 574-9358
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A24756
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0084350
MEDI/CAL
CA
05
—
GR0084350
—
CA
Enumeration date
06/09/2006
Last updated
06/24/2008
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