Healthcare Provider Details

I. General information

NPI: 1205924511
Provider Name (Legal Business Name): ORANGE COUNTY EAR, NOSE & THROAT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ODYSSEY STE 100
IRVINE CA
92618-3186
US

IV. Provider business mailing address

24411 HEALTH CENTER DRIVE SUITE 600
LAGUNA HILLS CA
92653
US

V. Phone/Fax

Practice location:
  • Phone: 949-679-9000
  • Fax: 949-679-9001
Mailing address:
  • Phone: 949-305-8000
  • Fax: 949-305-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCA

VIII. Authorized Official

Name: MRS. MICHELLE CRYSTAL DENA
Title or Position: OFFICE MANAGER
Credential:
Phone: 949-305-8252