Oc Latino Medical Group Inc

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A24756 Issued in CA

Legal business name

OC LATINO MEDICAL GROUP INC

Practice address

767 W 19TH Street
101
Costa Mesa, CA 92627

Phone

(949) 574-2121

Fax

(949) 574-9358

NPI assigned

Jun 9, 2006

Organization subpart

No

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

Authorized official

Name

Gaston F Cilliani, MD

Title

MD

Phone

(949) 574-2121

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1609817626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "767 W 19TH STREET",
            "address_2": "101",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "92627",
            "telephone_number": "949-574-2121",
            "fax_number": "949-574-9358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "767 W 19TH STREET",
            "address_2": "101",
            "city": "COSTA MESA",
            "state": "CA",
            "postal_code": "92627",
            "telephone_number": "949-574-2121",
            "fax_number": "949-574-9358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OC LATINO MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-09",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "CILLIANI",
        "authorized_official_first_name": "GASTON",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "949-574-2121",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A24756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0084350",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI/CAL",
            "identifier": "GR0084350",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Costa Mesa, CA
• Providers in Costa Mesa, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; 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.