Healthcare Provider Details

I. General information

NPI: 1285968909
Provider Name (Legal Business Name): CCOC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 03/11/2020
Certification Date: 03/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CORPORATE DR STE 102
LADERA RANCH CA
92694-2113
US

IV. Provider business mailing address

333 CORPORATE DR STE 102
LADERA RANCH CA
92694-2113
US

V. Phone/Fax

Practice location:
  • Phone: 949-276-2446
  • Fax: 949-276-2449
Mailing address:
  • Phone: 949-276-2446
  • Fax: 949-276-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG58587
License Number StateCA

VIII. Authorized Official

Name: DR. STEPHEN S EHRLICH
Title or Position: OWNER
Credential: MD
Phone: 949-276-2446