Provider Demographics
NPI:1124130471
Name:MACINA, STEVEN (DO)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:MACINA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25421 SPINDLEWOOD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:866-262-9066
Mailing Address - Fax:562-866-5730
Practice Address - Street 1:8201 NEWMAN AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-7059
Practice Address - Country:US
Practice Address - Phone:714-375-5405
Practice Address - Fax:714-375-5408
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A66252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX66251Medicaid
CA00AX66251Medicaid
CA20A6625AMedicare ID - Type Unspecified