1194908293 NPI number — PEDIATRIC SURGICAL SPECIALISTS 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 1194908293 NPI number — PEDIATRIC SURGICAL SPECIALISTS OF ORANGE COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC SURGICAL SPECIALISTS 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:
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:
1194908293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/12/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 W LA VETA AVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-4231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-361-4480
Provider Business Mailing Address Fax Number:
714-361-4490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 W LA VETA AVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-4231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-361-4480
Provider Business Practice Location Address Fax Number:
714-361-4490
Provider Enumeration Date:
12/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BARRETTA
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
714-361-4480

Provider Taxonomy Codes

  • Taxonomy code: 2086S0120X , with the licence number:  G79479 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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