| South Coast Family Medical Center Inc | |
|
25500 Rancho Niguel Rd Ste 100 Laguna Niguel CA 92677-7373 | |
| (949) 643-8921 | |
| (949) 643-3914 |
| Full Name | South Coast Family Medical Center Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 25500 Rancho Niguel Rd Ste 100, Laguna Niguel, California |
| Authorized Official Name and Position | Michael Alan Kent (OWNER) |
| Authorized Official Contact | 9496438921 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Coast Family Medical Center Inc 25500 Rancho Niguel Rd Ste 100 Laguna Niguel CA 92677-7373 Ph: (949) 643-8921 | South Coast Family Medical Center Inc 25500 Rancho Niguel Rd Ste 100 Laguna Niguel CA 92677-7373 Ph: (949) 643-8921 |
| NPI Number | 1902003791 |
|---|---|
| Provider Enumeration Date | 06/27/2007 |
| Last Update Date | 05/27/2008 |
| Medicare PECOS PAC ID | 4486694320 |
|---|---|
| Medicare Enrollment ID | O20050510000569 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902003791 | NPI | - | NPPES |
| 1952335598 | Other | CA | NPI MICHAEL KENT MD |
| A37009 | Other | CA | BLUE CROSS LICENSE |
| ZZZ26875Z | Other | CA | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | A37009 (California) | Primary |
| Provider Name | Michael A Kent |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952335598 PECOS PAC ID: 4486732112 Enrollment ID: I20080422000432 |
| Provider Name | Lauren Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1457647901 PECOS PAC ID: 4587889514 Enrollment ID: I20140708001669 |
| Provider Name | Christopher Michael Davis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1356637813 PECOS PAC ID: 4880819457 Enrollment ID: I20140716000393 |
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