Provider Demographics
NPI:1124502265
Name:SADDLEBACK MEDICAL GROUP, INC
Entity type:Organization
Organization Name:SADDLEBACK MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-465-8155
Mailing Address - Street 1:24221 CALLE DE LA LOUISA STE 400
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7632
Mailing Address - Country:US
Mailing Address - Phone:949-465-8155
Mailing Address - Fax:949-465-8159
Practice Address - Street 1:24331 EL TORO RD STE 330
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-2754
Practice Address - Country:US
Practice Address - Phone:949-716-0833
Practice Address - Fax:949-581-0694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SADDLEBACK MEDICAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty