MEDICARE: COMMUNITY CARE HEALTH CENTERS

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	207V00000X	Obstetrics & Gynecology Physician	550000166	CA

General Provider Information

NPI Number	:	1194871137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY CARE HEALTH CENTERS

Provider Business Mailing Address
First Line	:	8041 NEWMAN AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-7034
Country	:	US
Telephone Number	:	714-500-0200
Fax Number	:	714-842-0716

Provider Business Practice Location Address
First Line	:	1241 W 17TH ST
Second Line	:	SUITE 1
City	:	SANTA ANA
State	:	CA
Zip	:	92706-3459
Country	:	US
Telephone Number	:	714-285-9811
Fax Number	:	714-285-9822

Authorized Official
Title or Position	:	CFO
Name	:	TRACEY K GOULD
Credential	:
Telephone Number	:	714-500-0200

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	07/21/2008

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