| South Coast Medical Group Family And Sports Medicine | |
|
5 Journey Ste 130 Aliso Viejo CA 92656-5330 | |
| (949) 360-1069 | |
| (949) 389-8968 |
| Full Name | South Coast Medical Group Family And Sports Medicine |
|---|---|
| Speciality | Clinic/Center |
| Location | 5 Journey Ste 130, Aliso Viejo, California |
| Authorized Official Name and Position | Johnna Gherardini (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9493601069 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Coast Medical Group Family And Sports Medicine 5 Journey Ste 130 Aliso Viejo CA 92656-5330 Ph: (949) 360-1069 | South Coast Medical Group Family And Sports Medicine 5 Journey Ste 130 Aliso Viejo CA 92656-5330 Ph: (949) 360-1069 |
| NPI Number | 1649337221 |
|---|---|
| Provider Enumeration Date | 01/02/2007 |
| Last Update Date | 07/30/2015 |
| Medicare PECOS PAC ID | 5991793531 |
|---|---|
| Medicare Enrollment ID | O20040503001735 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649337221 | NPI | - | NPPES |
| 1619061397 | Other | CA | JOHN CHENG, MD |
| 1598723058 | Other | CA | ARCHANNA BHOGILL, MD |
| 1861586554 | Other | CA | SHANNON O'CONNOR, MD |
| 1932284478 | Other | CA | ERIC CLARK, MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| 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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