| South Coast Medical Group Orange County | |
|
5 Journey Ste 130 Aliso Viejo CA 92656-5330 | |
| (949) 235-6142 | |
| Not Available |
| Full Name | South Coast Medical Group Orange County |
|---|---|
| Speciality | Family Medicine |
| Location | 5 Journey Ste 130, Aliso Viejo, California |
| Authorized Official Name and Position | Shannon Michele O'connor (OWNER/MEDICAL DIRECTOR) |
| Authorized Official Contact | 9492356142 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Coast Medical Group Orange County 5 Journey Ste 130 Aliso Viejo CA 92656-5330 Ph: (949) 235-6142 | South Coast Medical Group Orange County 5 Journey Ste 130 Aliso Viejo CA 92656-5330 Ph: (949) 235-6142 |
| NPI Number | 1700515731 |
|---|---|
| Provider Enumeration Date | 06/06/2022 |
| Last Update Date | 06/07/2024 |
| Medicare PECOS PAC ID | 0244600070 |
|---|---|
| Medicare Enrollment ID | O20230112000028 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700515731 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Secondary |
| Provider Name | Shannon O Connor |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861586554 PECOS PAC ID: 6901090455 Enrollment ID: I20101029000057 |
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