SOUTH COUNTY URGENT CARE MEDICAL CORPORATION (NPI# 1083822639) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083822639 |
| Entity Type | Organization |
| Organization Name | SOUTH COUNTY URGENT CARE MEDICAL CORPORATION |
| Practice Address |
1300 Avenida Vista Hermosa #100 San Clemente CA 92673-6315 |
| Practice Telephone | 9492188050 |
| Practice Fax Number | 9492188051 |
| Mailing Telephone | 9492188050 |
| Mailing Fax Number | 9492188051 |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2018-03-26 |
| Authorized Official Name | DR. JOHN GENTILE (CEO) |
| Authorized Official Telephone | 9492188050 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207P00000X | Emergency Medicine | FNP30274 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | BLUE SHIELD | ZZZ05603Z | 01 |
| Street Address |
1300 AVENIDA VISTA HERMOSA #100 |
| City | SAN CLEMENTE |
| State | CA |
| Zip Code | 92673-6315 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336186493 | Christopher Scott Carlin | Dermatology | 1300 Avenida Vista Hermosa, Suite 240, San Clemente, CA 92673-6315 | 2006-05-31 |
| 1356798789 | Carrie Crawford | Nurse Practitioner | 1300 Avenida Vista Hermosa, San Clemente, CA 92673-6315 | 2016-05-16 |
| 1023462074 | Sepideh Forstie | Chiropractor | 1300 Avenida Vista Hermosa, Ste 100, San Clemente, CA 92673-6315 | 2016-04-15 |
| 1174990188 | Petra G Gomez | Technician, Pathology | 1300 Avenida Vista Hermosa, Suite 100, San Clemente, CA 92673-6315 | 2015-08-25 |
| 1588049944 | Allergy All Inc | Specialist | 1300 Avenida Vista Hermosa, Suite 100, San Clemente, CA 92673-6315 | 2015-07-28 |
| 1104189570 | Sepideh Forstie | Chiropractor | 1300 Avenida Vista Hermosa, Suite 100, San Clemente, CA 92673-6315 | 2012-06-20 |
| 1386903110 | Eva Marie Gentile, Md Inc | General Practice | 1300 Avenida Vista Hermosa, 100, San Clemente, CA 92673-6315 | 2012-05-14 |
| 1154642452 | San Clemente Family Medicine | Family Medicine | 1300 Avenida Vista Hermosa, Suite 200, San Clemente, CA 92673-6315 | 2010-06-21 |
| 1376795617 | Seema Khan | Internal Medicine | 1300 Avenida Vista Hermosa, Ste 250, San Clemente, CA 92673-6315 | 2008-10-17 |
| 1215102751 | Margaret Anne Vanblerk | Pediatrics | 1300 Avenida Vista Hermosa, Suite 250, San Clemente, CA 92673-6315 | 2008-04-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497246474 | Cynthia Hull Warren | Nutritionist | 2027 Via Concha, San Clemente, CA 92673 | 2018-05-24 |
| 1063942688 | Trinh T Tran | Pharmacist | 638 Camino De Los Mares #d5, San Clemente, CA 92673 | 2017-06-15 |
| 1427421791 | Jessica A Currens | Nurse Practitioner | 1001 Avenida Pico Ste C517, San Clemente, CA 92673 | 2015-11-08 |
| 1184010647 | Garrett Bryon Rubio | Student in an Organized Health Care Education/Training Program | 905 Calle Amanecer Ste. 265, San Clemente, CA 92673 | 2015-04-11 |
| 1255733853 | Body Mind Spirit Iop Inc | Psychologist | 665 Camino De Los Mares Ste 104, San Clemente, CA 92673 | 2014-09-25 |
| 1548677438 | Jessica Ann Riley | Dermatology | 1300 Avenida Vista Hermosa Ste 150, San Clemente, CA 92673 | 2014-07-13 |
| 1427398718 | Veena Menda | Specialist | 2232 Calle Opalo, San Clemente, CA 92673 | 2013-02-22 |
| 1124383781 | Alexandra Rose Corporation | Substance Abuse Rehabilitation Facility | 4009 Calle Abril, San Clemente, CA 92673 | 2012-07-10 |
| 1457612574 | Noelle J Deckman | Psychologist | 629 Camino De Los Mares Ste 207a, San Clemente, CA 92673 | 2012-06-05 |
| 1851686471 | Meighan Bartholomew Merono | Pharmacist | 990 Avenida Vista Hermosa, San Clemente, CA 92673 | 2011-06-10 |
| Find all providers in zip 92673 | ||||
| Taxonomy Code | 207P00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: mofified source] - Additional Resources: American Board of Emergency Medicine, 2007. http://www.abem.org/public/; American Osteopathic Board of Emergency Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Emergency Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093361925 | Scott Lawrence Ryan | Emergency Medicine | 1833 S El Camino Real, San Clemente, CA 92672-3245 | 2019-08-15 |
| 1073711792 | Christopher Melville | Emergency Medicine | 210 Calle Potro, San Clemente, CA 92672-4551 | 2007-07-03 |
| 1407975501 | Rajesh Kadakia | Emergency Medicine | 910 S El Camino Real Ste A, San Clemente, CA 92672-4279 | 2007-03-28 |
| 1669577128 | Kenneth B. Pierce | Emergency Medicine | 305 Cazador Ln Apt C, San Clemente, CA 92672-6642 | 2006-09-13 |
| 1033142914 | Seric Cusick | Emergency Medicine | 1713 S Ola Vis, San Clemente, CA 92672-4343 | 2006-07-07 |
| 1821272295 | Colin Xephary Jairam | Emergency Medicine | 1031 Avenida Pico, Suite 103, San Clemente, CA 92673-6352 | 2007-12-20 |
| 1033281993 | Cep America - California | Emergency Medicine | 654 Camino De Los Mares, San Clemente, CA 92673-2827 | 2006-11-15 |
| 1346327053 | Larry Burbridge | Emergency Medicine | 654 Camino De Los Mares, Emergency Department, San Clemente, CA 92673-2827 | 2006-11-01 |
| 1518980754 | Timothy O Roham | Emergency Medicine | 629 Camino De Los Mares, Suite # 103, San Clemente, CA 92673-2834 | 2006-07-26 |
| 1356365290 | Hubert E Wong | Emergency Medicine | 654 Camino De Los Mares, San Clemente, CA 92673-2827 | 2006-07-26 |
| Find all providers in SAN CLEMENTE | ||||
| City | SAN CLEMENTE |
| Zip Code | 92673 |
Please comment or provide details below to improve the information on SOUTH COUNTY URGENT CARE MEDICAL CORPORATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.