NPIMap

Organization Active NPI

TLC Pediatrics Medical Group

  • Specialist
  • San Juan Capistrano, CA
National Provider Identifier
1356303168
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
TLC PEDIATRICS MEDICAL GROUP
Practice address
30210 Rancho Viejo Rd
Suite a
San Juan Capistrano, CA 92675-1574
Phone
(949) 493-7337
Fax
(949) 493-1418
NPI assigned
Apr 5, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Josiane Suzanne Dagostino, CMM
Title
Medical Manager
Phone
(949) 493-1383

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X CA Primary

Addresses

Primary practice location

30210 Rancho Viejo Rd
Suite a
San Juan Capistrano, CA 92675-1574

Mailing address

30210 Rancho Viejo Rd
Suite a
San Juan Capistrano, CA 92675-1574
Phone (949) 493-7337

Other identifiers 1

IdentifierTypeStateIssuer
GR0081160MedicaidCA

National Provider Directory

National Provider Directory

Locations

30210 Rancho Viejo Rd
Ste A
San Juan Capistrano, CA 92675
Phone (949) 493-1383

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1356303168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30210 RANCHO VIEJO RD",
            "address_2": "SUITE A",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751574",
            "telephone_number": "949-493-7337",
            "fax_number": "949-493-1418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30210 RANCHO VIEJO RD",
            "address_2": "SUITE A",
            "city": "SAN JUAN CAPISTRANO",
            "state": "CA",
            "postal_code": "926751574",
            "telephone_number": "949-493-7337",
            "fax_number": "949-493-1418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TLC PEDIATRICS MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "DAGOSTINO",
        "authorized_official_first_name": "JOSIANE",
        "authorized_official_middle_name": "SUZANNE",
        "authorized_official_title_or_position": "MEDICAL MANAGER",
        "authorized_official_telephone_number": "949-493-1383",
        "authorized_official_credential": "CMM"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0081160",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan Capistrano, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.