MEDICARE: CHILDRENS HOSPITAL OF ORANGE COUNTY

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	261QP2300X	Primary Care Clinic/Center	CMM71110F	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CMM7110F	OTHER	CA	GROUP MEDI-CAL ID NUMBER

General Provider Information

NPI Number	:	1568599769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDRENS HOSPITAL OF ORANGE COUNTY

Provider Business Mailing Address
First Line	:	10602 CHAPMAN AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-3103
Country	:	US
Telephone Number	:	714-532-7921
Fax Number	:

Provider Business Practice Location Address
First Line	:	10602 CHAPMAN AVE
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92840-3103
Country	:	US
Telephone Number	:	714-532-7921
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. GINA SUE CADOGAN
Credential	:	C..P.C.
Telephone Number	:	714-289-4818

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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Directions to “CHILDRENS HOSPITAL OF ORANGE COUNTY ” Practice Location

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