Healthcare Provider Details

I. General information

NPI: 1457614950
Provider Name (Legal Business Name): ORANGE COUNTY PHYSICAL MEDICINE GROUP, A PROFESSIONAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8840 WARNER AVE SUITE 201
FOUNTAIN VALLEY CA
92708-3232
US

IV. Provider business mailing address

8840 WARNER AVE SUITE 201
FOUNTAIN VALLEY CA
92708-3232
US

V. Phone/Fax

Practice location:
  • Phone: 714-848-3603
  • Fax: 714-848-3605
Mailing address:
  • Phone: 714-848-3603
  • Fax: 714-848-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC14902
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG15995
License Number StateCA

VIII. Authorized Official

Name: DR. IRWIN ARLUK
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 714-848-3603