Healthcare Provider Details

I. General information

NPI: 1912257478
Provider Name (Legal Business Name): OC PHYSICIANS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17911 SKY PARK CIR SUITE L
IRVINE CA
92614-6322
US

IV. Provider business mailing address

17911 SKY PARK CIR SUITE L
IRVINE CA
92614-6322
US

V. Phone/Fax

Practice location:
  • Phone: 949-336-4646
  • Fax:
Mailing address:
  • Phone: 949-336-4646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberDC21715
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA35456
License Number StateCA

VIII. Authorized Official

Name: DR. COREY ARTHUR HOLLIS
Title or Position: CLINIC DIRECTOR
Credential: D.C.
Phone: 949-336-4317