Provider Demographics
NPI:1386605822
Name:SADDLEBACK MEDICAL GROUP INC
Entity type:Organization
Organization Name:SADDLEBACK MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRENBEATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-465-8155
Mailing Address - Street 1:24221 CALLE DE LA LOUISA
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-7638
Mailing Address - Country:US
Mailing Address - Phone:949-465-8155
Mailing Address - Fax:949-465-8159
Practice Address - Street 1:24221 CALLE DE LA LOUISA
Practice Address - Street 2:SUITE 400
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-7638
Practice Address - Country:US
Practice Address - Phone:949-465-8155
Practice Address - Fax:949-465-8159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W17795Medicare UPIN
CAW13066Medicare PIN