Healthcare Provider Details

I. General information

NPI: 1619891553
Provider Name (Legal Business Name): ORANGE PREVENTION AND TREATMENT INTEGRATED MEDICAL ASSISTANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 GARDEN GROVE BLVD
GARDEN GROVE CA
92841-4208
US

IV. Provider business mailing address

505 CITY PKWY W
ORANGE CA
92868-2924
US

V. Phone/Fax

Practice location:
  • Phone: 661-733-2858
  • Fax:
Mailing address:
  • Phone: 661-733-2858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KELLY ANN NELSON
Title or Position: EXECUTIVE DIRECTOR, MEDI-CAL/CALAIM
Credential: DSW
Phone: 661-733-2858