Healthcare Provider Details

I. General information

NPI: 1003035882
Provider Name (Legal Business Name): PERINATAL DX MEDICAL GRP OR ORANGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11180 WARNER AVE #263
FOUNTAIN VALLEY CA
92708-7501
US

IV. Provider business mailing address

11180 WARNER AVE #263
FOUNTAIN VALLEY CA
92708-7501
US

V. Phone/Fax

Practice location:
  • Phone: 714-241-9742
  • Fax: 714-241-0136
Mailing address:
  • Phone: 714-241-9742
  • Fax: 714-241-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VH0002X
TaxonomyHospice and Palliative Medicine (Obstetrics & Gynecology) Physician
License Number
License Number State

VIII. Authorized Official

Name: PAM R REED
Title or Position: SONOGRAPHER
Credential: RDMS
Phone: 714-241-9742