Organization
SADDLEBACK RESPIRATORY MEDICAL GRP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LELIA MCNICOL (OFFICE MANAGER)
(949) 643-3345
Entity
Organization
Contact information
Practice address
24451 HEALTH CENTER DR, LAGUNA HILLS, CA 92653-3689
(949) 837-4500
Mailing address
PO BOX 7630, LAGUNA NIGUEL, CA 92607-7630
(949) 643-3345
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G256840
BLUE SHIELD
—
05
—
00G256840
—
CA
01
—
ZZZ53020Y
BLUE CROSS/BLUE SHIELD
CA
Enumeration date
10/04/2006
Last updated
03/31/2016
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