Provider Demographics
NPI:1164523122
Name:ALLERGY & ASTHMA ASSOCIATES OF SOUTHERN CALIF INC
Entity type:Organization
Organization Name:ALLERGY & ASTHMA ASSOCIATES OF SOUTHERN CALIF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-364-2900
Mailing Address - Street 1:28202 CABOT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1247
Mailing Address - Country:US
Mailing Address - Phone:949-364-2900
Mailing Address - Fax:949-365-0117
Practice Address - Street 1:28202 CABOT RD STE 105
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1247
Practice Address - Country:US
Practice Address - Phone:949-364-2900
Practice Address - Fax:949-365-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW6384Medicare ID - Type Unspecified