Organization
BREAST SPECIALISTS MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURALYN R. MARKLE M.D. (PRESIDENT)
(949) 452-7200
Entity
Organization
Contact information
Practice address
24401 CALLE DE LA LOUISA, STE. 200, LAGUNA HILLS, CA 92653-3623
(949) 452-7200
Mailing address
PO BOX 5931, ORANGE, CA 92863-5931
(714) 571-5000
(714) 571-5055
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CJ2832
RAILROAD MEDICARE
—
05
—
GR0103910
—
CA
01
—
ZZZ01822Z
BLUE SHIELD OF CA
—
Enumeration date
08/16/2005
Last updated
08/15/2008
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