1356525182 NPI number — NORTH ORANGE COUNTY PEDIATRICS CHILES DAN W ET AL GEN PTRS

Table of content: (NPI 1356525182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356525182 NPI number — NORTH ORANGE COUNTY PEDIATRICS CHILES DAN W ET AL GEN PTRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH ORANGE COUNTY PEDIATRICS CHILES DAN W ET AL GEN PTRS
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:
1356525182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 LAGUNA RD
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92835-2523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-879-2980
Provider Business Mailing Address Fax Number:
714-879-5134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 LAGUNA RD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92835-2523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-879-2980
Provider Business Practice Location Address Fax Number:
714-879-5134
Provider Enumeration Date:
12/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BACHA
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
714-879-2980

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  A23480 , 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: GR0024380 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: A26098 . This is a "MEDICAL LIC NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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