1588692644 NPI number — MEDICAL CENTER OF GARDEN GROVE

Table of content: (NPI 1588692644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588692644 NPI number — MEDICAL CENTER OF GARDEN GROVE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL CENTER OF GARDEN GROVE
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:
6
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:
1588692644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
FILE 57483
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90074-7483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-300-4122
Provider Business Mailing Address Fax Number:
714-741-3322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12601 GARDEN GROVE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92843-1908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-537-5160
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARMIN
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
VP OF GOVT PROGRAMS, TENET
Authorized Official Telephone Number:
310-775-8043

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  060000152 , 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)

  • Identifier: ZZT40230F (OP) , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1039038 . This is a "CIGNA (US / PUERTO RICO)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123050 . This is a "COVENTRY HEALTH CARE KANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 884562490 . This is a "AETNA US HEALTHCARE (NATI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003666-0001 . This is a "PACIFICARE OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8126 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: HSC30230F (IP) , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZC3006Z . This is a "BS OF CALIFORNIA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com