| Oc Latino Medical Group Inc | |
|
767 W 19th Street 101 Costa Mesa CA 92627 | |
| (949) 574-2121 | |
| (949) 574-9358 |
| Full Name | Oc Latino Medical Group Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 767 W 19th Street, Costa Mesa, California |
| Authorized Official Name and Position | Gaston F Cilliani (MD) |
| Authorized Official Contact | 9495742121 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Oc Latino Medical Group Inc 767 W 19th Street 101 Costa Mesa CA 92627 Ph: (949) 574-2121 | Oc Latino Medical Group Inc 767 W 19th Street 101 Costa Mesa CA 92627 Ph: (949) 574-2121 |
| NPI Number | 1609817626 |
|---|---|
| Provider Enumeration Date | 06/09/2006 |
| Last Update Date | 06/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609817626 | NPI | - | NPPES |
| GR0084350 | Medicaid | CA | |
| GR0084350 | Other | CA | MEDI/CAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A24756 (California) | Primary |
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