Healthcare Provider Details

I. General information

NPI: 1639264278
Provider Name (Legal Business Name): ORANGE COUNTY FIRST MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1771 W. ROMNEYA DR. SUITE C
ANAHEIM CA
92801-1817
US

IV. Provider business mailing address

1771 W. ROMNEYA DR. SUITE C
ANAHEIM CA
92801-1817
US

V. Phone/Fax

Practice location:
  • Phone: 714-520-3000
  • Fax: 714-520-5742
Mailing address:
  • Phone: 714-520-3000
  • Fax: 714-520-5742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SYAM PRASAD GADDAM
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 714-636-9100