Healthcare Provider Details

I. General information

NPI: 1114483492
Provider Name (Legal Business Name): ORANGE COUNTY DIGESTIVE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 REYNOLDS AVE STE 125
IRVINE CA
92614-5563
US

IV. Provider business mailing address

1400 REYNOLDS AVE STE 125
IRVINE CA
92614-5563
US

V. Phone/Fax

Practice location:
  • Phone: 657-900-4536
  • Fax:
Mailing address:
  • Phone: 657-900-4536
  • Fax: 657-208-9732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ESSAM R QURAISHI
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 949-771-9910