Southern California Skin and Laser

Primary specialty

SpecialistTaxonomy code 174400000X

License

A68285 Issued in CA

Legal business name

SOUTHERN CALIFORNIA SKIN AND LASER

Practice address

22972 Moulton Pkwy Ste 106
Laguna Hills, CA 92653-1219

Phone

(949) 707-5734

Fax

(949) 707-1924

NPI assigned

Oct 15, 2007

Last updated

Oct 15, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Tanya Y Evans, M.D.NPI 1902908858

Title

Medical Director

Phone

(949) 707-5734

Specialties & licenses 1

Addresses

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tanya Y Evans, M.D.

  • Specialist
  • Laguna Niguel, CA
  • NPI 1902908858
  NPD (past) Authorized official
• Stacy Norman, P.A.

  • Specialist
  • Laguna Hills, CA
  • NPI 1417146655
  NPD (past)

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192406400000",
    "number": "1225227333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22972 MOULTON PKWY STE 106",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926531219",
            "telephone_number": "949-707-5734",
            "fax_number": "949-707-1924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22972 MOULTON PKWY STE 106",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "926531219",
            "telephone_number": "949-707-5734",
            "fax_number": "949-707-1924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN CALIFORNIA SKIN AND LASER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-15",
        "last_updated": "2007-10-15",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "TANYA",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "949-707-5734",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A68285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Southern California Riviera
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• Brianna Marie Southworth
• Holly Marie Spanggord, M.D.
• Morgan Speik, RD

• Specialist in Laguna Hills, CA
• Providers in Laguna Hills, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.