Basic Information
| Provider Information | |||||||||
| NPI: | 1033164017 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOUSECALL DOCTORS MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 260 CALLE CAMPESINO | ||||||||
| Address2: | |||||||||
| City: | SAN CLEMENTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926724553 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493661054 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23181 VERDUGO DR STE 103A | ||||||||
| Address2: | |||||||||
| City: | LAGUNA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926531313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493661053 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 11/30/2017 | ||||||||
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| AuthorizedOfficialLastName: | VINN | ||||||||
| AuthorizedOfficialFirstName: | NORMAN | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9493661054 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | CNC329272 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.