Healthcare Provider Details

I. General information

NPI: 1710398193
Provider Name (Legal Business Name): ORANGE COAST HEAD AND NECK SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 SAND CANYON AVE STE 310
IRVINE CA
92618-3716
US

IV. Provider business mailing address

16100 SAND CANYON AVE STE 310
IRVINE CA
92618-3716
US

V. Phone/Fax

Practice location:
  • Phone: 949-715-0500
  • Fax: 949-715-0503
Mailing address:
  • Phone: 949-715-0500
  • Fax: 949-715-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberW20172
License Number StateCA

VIII. Authorized Official

Name: LAURA RENTERIA
Title or Position: OFFICE MANAGER
Credential:
Phone: 949-715-0500