Healthcare Provider Details

I. General information

NPI: 1093515439
Provider Name (Legal Business Name): COLLEGE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 VICTORIA ST
COSTA MESA CA
92627-1995
US

IV. Provider business mailing address

301 VICTORIA ST
COSTA MESA CA
92627-1995
US

V. Phone/Fax

Practice location:
  • Phone: 949-574-3367
  • Fax:
Mailing address:
  • Phone: 949-574-3367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DAMINI PATEL
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 562-396-7168