Healthcare Provider Details

I. General information

NPI: 1366725590
Provider Name (Legal Business Name): PEDIATRIC DERMATOLOGY OF ORANGE COUNTY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 08/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 BARRANCA PKWY STE 160
IRVINE CA
92606-8226
US

IV. Provider business mailing address

3500 BARRANCA PKWY STE 160
IRVINE CA
92606-8226
US

V. Phone/Fax

Practice location:
  • Phone: 949-336-6569
  • Fax: 949-336-6570
Mailing address:
  • Phone: 949-336-6569
  • Fax: 949-336-6570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDIE J METZ
Title or Position: OWNER
Credential: MD
Phone: 949-336-6569