Laguna Tides Medical Group, Inc.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

20A9817 Issued in CA

Legal business name

LAGUNA TIDES MEDICAL GROUP, INC.

Practice address

30131 Town Center Dr
Suite 215
Laguna Niguel, CA 92677-2034

Phone

(949) 499-1337

Fax

(949) 499-4962

NPI assigned

Mar 22, 2007

Last updated

May 4, 2010By 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

Robert V. Eller, D.O.NPI 1770556201

Title

President

Phone

(949) 499-1337

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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.

• Robert V. Eller, D.O.

  • Internal Medicine Physician
  • West Linn, OR
  • NPI 1770556201
  NPD (past) Authorized official

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272931200000",
    "number": "1811014319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30131 TOWN CENTER DR",
            "address_2": "SUITE 215",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926772034",
            "telephone_number": "949-499-1337",
            "fax_number": "949-499-4962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30131 TOWN CENTER DR",
            "address_2": "SUITE 215",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926772034",
            "telephone_number": "949-499-1337",
            "fax_number": "949-499-4962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAGUNA TIDES MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-22",
        "last_updated": "2010-05-04",
        "status": "A",
        "authorized_official_last_name": "ELLER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "V.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "949-499-1337",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "20A9817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laguna Niguel Chiropractic
• Laguna Niguel MRI
• Laguna Niguel Speech and Language Center
• Laguna Niguel Surgery Center LLC
• Laguna Shores Mental Health, LLC
• Lynn Lam-Salvaggio, OTR
• Jim W Lam, M.D.
• Mary S Lam, PHARM.D.
• Nicole Lambert
• Katie Lamming, LCSW

• Internal Medicine Physician in Laguna Niguel, CA
• Providers in Laguna Niguel, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2010; 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.