MEDICARE: ORANGE COAST MEDICAL ASSOC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	A71393	CA

General Provider Information

NPI Number	:	1164647921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORANGE COAST MEDICAL ASSOC

Provider Business Mailing Address
First Line	:	3011 HARBOR BLVD
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3011 HARBOR BLVD
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-2504
Country	:	US
Telephone Number	:	951-278-9035
Fax Number	:

Authorized Official
Title or Position	:	OFFICE ADMIN
Name	:	PAULA CAVANAUGH
Credential	:
Telephone Number	:	951-278-9035

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	08/22/2020

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Directions to “ORANGE COAST MEDICAL ASSOC ” Practice Location

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