Healthcare Provider Details

I. General information

NPI: 1912265257
Provider Name (Legal Business Name): OC PEDIATRICS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR STE 150
FOOTHILL RANCH CA
92610-2844
US

IV. Provider business mailing address

26700 TOWNE CENTRE DR STE 150
FOOTHILL RANCH CA
92610-2844
US

V. Phone/Fax

Practice location:
  • Phone: 949-837-7337
  • Fax: 949-837-7347
Mailing address:
  • Phone: 949-837-7337
  • Fax: 949-837-7347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA94330
License Number StateCA

VIII. Authorized Official

Name: AMINA HASSAN-ELSAYED
Title or Position: PRESIDENT
Credential: MD
Phone: 949-241-0117