Organization
SOUTH COAST MEDICAL GROUP FAMILY AND SPORTS MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNA GHERARDINI BSBA (EXECUTIVE DIRECTOR)
(949) 360-1069
Entity
Organization
Contact information
Practice address
5 JOURNEY STE 130, ALISO VIEJO, CA 92656-5330
(949) 360-1069
(949) 389-8968
Mailing address
5 JOURNEY STE 130, ALISO VIEJO, CA 92656-5330
(949) 360-1069
(949) 389-8968
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598723058
ARCHANNA BHOGILL, MD
CA
01
—
1619061397
JOHN CHENG, MD
CA
01
—
1861586554
SHANNON O'CONNOR, MD
CA
01
—
1932284478
ERIC CLARK, MD
CA
Enumeration date
01/02/2007
Last updated
07/30/2015
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