Healthcare Provider Details

I. General information

NPI: 1588692644
Provider Name (Legal Business Name): MEDICAL CENTER OF GARDEN GROVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12601 GARDEN GROVE BLVD
GARDEN GROVE CA
92843-1908
US

IV. Provider business mailing address

FILE 57483
LOS ANGELES CA
90074-7483
US

V. Phone/Fax

Practice location:
  • Phone: 714-537-5160
  • Fax:
Mailing address:
  • Phone: 626-300-4122
  • Fax: 714-741-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number060000152
License Number StateCA

VIII. Authorized Official

Name: MR. CRAIG C. ARMIN
Title or Position: VP OF GOVT PROGRAMS, TENET
Credential:
Phone: 310-775-8043