Healthcare Provider Details

I. General information

NPI: 1306699814
Provider Name (Legal Business Name): OCEAN PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 IRVINE AVE STE 152
COSTA MESA CA
92627-6649
US

IV. Provider business mailing address

2651 IRVINE AVE STE 152
COSTA MESA CA
92627-6649
US

V. Phone/Fax

Practice location:
  • Phone: 949-781-3040
  • Fax:
Mailing address:
  • Phone: 949-781-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMY STEWART
Title or Position: EXECUTIVE ADVISOR
Credential:
Phone: 949-781-3040