Healthcare Provider Details

I. General information

NPI: 1073927877
Provider Name (Legal Business Name): SOUTH ORANGE COUNTY COMMUNITY COLLEGE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2014
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 IRVINE CENTER DR
IRVINE CA
92618-0301
US

IV. Provider business mailing address

5500 IRVINE CENTER DR STUDENT HEATLH, WELLNESS & VETERANS CENTER - SSC 150
IRVINE CA
92618-0301
US

V. Phone/Fax

Practice location:
  • Phone: 949-451-5221
  • Fax: 949-451-5393
Mailing address:
  • Phone: 949-451-5221
  • Fax: 949-451-5393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NANCY MONTGOMERY
Title or Position: DIRECTOR HEALTH,WELLNESS,VET CENTER
Credential:
Phone: 949-451-5273