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Organization
SAN DIEGO PROFESSIONAL GROUP, P. C.
Active
Organization
SAN DIEGO PROFESSIONAL GROUP, P. C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK CALARCO DO (FACILITY CEO)
(615) 712-5862
Entity
Organization
Contact information
Practice address
24552 PACIFIC PARK DR, ALISO VIEJO, CA 92656-3033
(615) 727-8416
(615) 457-8094
Mailing address
200 POWELL PL, ATTN: LEGAL DEPARTMENT, BRENTWOOD, TN 37027-7514
(615) 732-1605
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
20A6119
CA
207RA0401X
Addiction Medicine (Internal Medicine) Physician
20A6119
CA
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
20A6119
CA
Other
Enumeration date
08/16/2016
Last updated
08/25/2021
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