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Organization
LAGUNA TIDES MEDICAL GROUP, INC.
Active
Organization
LAGUNA TIDES MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT V. ELLER D.O. (PRESIDENT)
(949) 499-1337
Entity
Organization
Contact information
Practice address
30131 TOWN CENTER DR, SUITE 215, LAGUNA NIGUEL, CA 92677-2034
(949) 499-1337
(949) 499-4962
Mailing address
30131 TOWN CENTER DR, SUITE 215, LAGUNA NIGUEL, CA 92677-2034
(949) 499-1337
(949) 499-4962
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
20A9817
CA
Other
Enumeration date
03/22/2007
Last updated
05/04/2010
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