1811070253 NPI number — SOUTH ORANGE COUNTY CARDIOLOGY GRP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811070253 NPI number — SOUTH ORANGE COUNTY CARDIOLOGY GRP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH ORANGE COUNTY CARDIOLOGY GRP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811070253
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/11/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24411 HEALTH CENTER DR
Provider Second Line Business Mailing Address:
SUITE 550
Provider Business Mailing Address City Name:
LAGUNA HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92653-3651
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-770-6252
Provider Business Mailing Address Fax Number:
949-916-0140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24411 HEALTH CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 550
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-3651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-770-6252
Provider Business Practice Location Address Fax Number:
949-916-0140
Provider Enumeration Date:
10/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZIAEIAN
Authorized Official First Name:
TARA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
949-770-6252

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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