Laguna Beach Community Clinic, Inc.

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

License

596420 Issued in CA

Legal business name

LAGUNA BEACH COMMUNITY CLINIC, INC.

Practice address

362 3Rd St
Laguna Beach, CA 92651-2307

Phone

(949) 494-0761

Fax

(949) 494-3154

NPI assigned

Aug 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jorge Rubal, M.D., M.B.ANPI 1174713911

Title

Ceo/Cmo

Phone

(949) 494-0761

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Laguna Beach Community Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Enrollment records 2

Federally qualified health center certification: CCN 921123

Legal name

LAGUNA BEACH COMMUNITY CLINIC INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Feb 1, 2019

Last certification

Feb 1, 2019

Ownership / control type

For profit – corporation

Organization structure

CorporationNon-profit

Incorporated

Dec 4, 1985 in CA

Enrollment address

362 3Rd St
Laguna Beach, CA 92651-2307

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Jorge Rubal, MD, MBA

  • Family Medicine Physician
  • Laguna Beach, CA
  • NPI 1174713911

  Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jorge Rubal, MD, MBA

  • Family Medicine Physician
  • Laguna Beach, CA
  • NPI 1174713911
  Medicare reassignment Care Compare group NPD Authorized official
• Farangis Jalali, M.D

  • Family Medicine Physician
  • Perris, CA
  • NPI 1841312972
  Medicare reassignment Care Compare group NPD
• Chau Minh Ngo, M.D.

  • Internal Medicine Physician
  • Laguna Beach, CA
  • NPI 1477613339
  Medicare reassignment Care Compare group NPD
• Stephanie Ramirez

  • Clinical Social Worker
  • Fontana, CA
  • NPI 1720554306
  Medicare reassignment NPD
• Andrea Stokke

  • Marriage & Family Therapist
  • Newport Beach, CA
  • NPI 1942879168
  Medicare reassignment NPD
• Diana Irene Lithgow, RN, FNP, PHD

  • Family Nurse Practitioner
  • Laguna Beach, CA
  • NPI 1063634715
  Medicare reassignment
• Eduardo J Guzman, MD

  • Obstetrics & Gynecology Physician
  • Norwalk, CA
  • NPI 1982610887
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740528000000",
    "number": "1225149222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "362 3RD ST",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926512307",
            "telephone_number": "949-494-0761",
            "fax_number": "949-494-3154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "362 3RD ST",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926512307",
            "telephone_number": "949-494-0761",
            "fax_number": "949-494-3154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAGUNA BEACH COMMUNITY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A",
        "authorized_official_last_name": "RUBAL",
        "authorized_official_first_name": "JORGE",
        "authorized_official_title_or_position": "CEO/CMO",
        "authorized_official_telephone_number": "949-494-0761",
        "authorized_official_credential": "M.D., M.B.A"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "CA",
            "license": "596420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EAPC",
            "identifier": "EAP11948F",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZT11948F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Laguna Beach Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Timothy Earl Korber, M.D.
• Christopher M Kovacs
• Gabor L Kovacs, M.D.
• Kaitlyn Kuo, PSYD
• Laguna Aesthetics & Family Wellness Center, Inc
• Laguna Beach Dental Excellence
• Laguna Beach Recovery
• Laguna Beach Recovery LLC
• Laguna Beach Recovery LLC
• Laguna Beach Rehab Inc

• Community Health Clinic/Center in Laguna Beach, CA
• Providers in Laguna Beach, CA by specialty
• Community Health Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.