NPIMap

Organization Active NPI

South County Medical

  • Physician Assistant
  • Trabuco Canyon, CA
National Provider Identifier
1467697276
Registry record updated Nov 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA11666 Issued in CA
Legal business name
SOUTH COUNTY MEDICAL
Practice address
36 Brassie LN
Trabuco Canyon, CA 92679-4954
Phone
(949) 243-4741
Fax
(949) 713-5163
NPI assigned
Dec 8, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2011

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

Authorized official

Name
Mr. Richard Licon, PA-CNPI 1740428101
Title
Ceo/President
Phone
(949) 243-4741

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X PA11666 CA Primary

Addresses

Primary practice location

36 Brassie LN
Trabuco Canyon, CA 92679-4954

Mailing address

P.O. Box 81044
Rancho Santa Margarita, CA 92688
Phone (949) 243-4741

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1228694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321228800000",
    "number": "1467697276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 81044",
            "city": "RANCHO SANTA MARGARITA",
            "state": "CA",
            "postal_code": "92688",
            "telephone_number": "949-243-4741",
            "fax_number": "949-713-5163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 BRASSIE LN",
            "city": "TRABUCO CANYON",
            "state": "CA",
            "postal_code": "926794954",
            "telephone_number": "949-243-4741",
            "fax_number": "949-713-5163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH COUNTY MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-08",
        "last_updated": "2011-11-14",
        "status": "A",
        "authorized_official_last_name": "LICON",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "949-243-4741",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA11666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Trabuco Canyon, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; 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.