1871910489 NPI number — CHILDREN'S HOSPITAL OF ORANGE COUNTY

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 1871910489 NPI number — CHILDREN'S HOSPITAL OF ORANGE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S HOSPITAL OF ORANGE COUNTY
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:
CHOC PSYCH
Provider Other Organization Name Type Code:
3
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:
1871910489
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 W LA VETA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-4203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-267-0400
Provider Business Mailing Address Fax Number:
949-221-0004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 RED HILL AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-5518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-267-0400
Provider Business Practice Location Address Fax Number:
949-221-0004
Provider Enumeration Date:
03/20/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KELLY
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, CS BUSINESS SERVICES
Authorized Official Telephone Number:
714-509-7964

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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