South County Medical
NPI #1467697276 in Trabuco Canyon, California
Provider Information
- NPI Number
- 1467697276
- Entity Type
- Organization
- Organization Name
- South County Medical
- Primary Specialty
- Physician Assistant
- Enumeration Date
- Dec 8, 2008
- Last Updated
- Nov 14, 2011
Practice Location
- Address
- 36 BRASSIE LN
- City
- Trabuco Canyon
- State
- California
- ZIP Code
- 92679-4954
- Phone
- (949) 243-4741
Authorized Official
- Name
- MR. RICHARD LICON, PA-C
- Title
- CEO/PRESIDENT
- Phone
- (949) 243-4741
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physician Assistant |
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