Organization
ADOBE MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAMRAN GHODSIAN MD (PRESIDENT)
(714) 662-1515
Entity
Organization
Contact information
Practice address
31921 CAMINO CAPISTRANO, SUITE 19, SAN JUAN CAPISTRANO, CA 92675-3210
(949) 487-2323
(949) 487-3630
Mailing address
24502 PACIFIC PARK DR, SUITE 105, ALISO VIEJO, CA 92656-3033
(949) 362-1515
(949) 362-7548
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0082570
—
CA
01
—
ZZZ257218Z
BLUE SHIELD PROVIDER #
CA
Enumeration date
08/31/2006
Last updated
11/21/2011
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