| Vitruvianmd Inc | |
|
30131 Town Center Dr Ste 295 Laguna Niguel CA 92677-2086 | |
| (619) 363-5347 | |
| (949) 288-0375 |
| Full Name | Vitruvianmd Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 30131 Town Center Dr Ste 295, Laguna Niguel, California |
| Authorized Official Name and Position | Jonathan Melton Lish (OWNER/CEO) |
| Authorized Official Contact | 5593083017 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitruvianmd Inc 30131 Town Center Dr Ste 295 Laguna Niguel CA 92677-2086 Ph: (619) 363-5347 | Vitruvianmd Inc 30131 Town Center Dr Ste 295 Laguna Niguel CA 92677-2086 Ph: (619) 363-5347 |
| NPI Number | 1053031716 |
|---|---|
| Provider Enumeration Date | 09/01/2022 |
| Last Update Date | 01/18/2024 |
| Medicare PECOS PAC ID | 4385013366 |
|---|---|
| Medicare Enrollment ID | O20221214000644 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053031716 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Jonathan Melton Lish |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811459456 PECOS PAC ID: 7911376991 Enrollment ID: I20221214000705 |
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