Healthcare Provider Details

I. General information

NPI: 1366984247
Provider Name (Legal Business Name): OC BACK DOCTORS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17264 RED HILL
IRVINE CA
92614
US

IV. Provider business mailing address

17264 RED HILL AVE
IRVINE CA
92614
US

V. Phone/Fax

Practice location:
  • Phone: 949-724-0011
  • Fax: 949-724-0012
Mailing address:
  • Phone: 949-724-0011
  • Fax: 949-724-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberG072815
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT D HIDALGO JR.
Title or Position: OWNER
Credential: M.D
Phone: 714-397-5029