Healthcare Provider Details

I. General information

NPI: 1619367794
Provider Name (Legal Business Name): ORANGE COUNTY PALLIATIVE CARE GROUP, A PROFESSIONAL MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2015
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23141 VERDUGO DR SUITE #201
LAGUNA HILLS CA
92653-1341
US

IV. Provider business mailing address

23141 VERDUGO DR SUITE #201
LAGUNA HILLS CA
92653-1341
US

V. Phone/Fax

Practice location:
  • Phone: 949-215-5055
  • Fax:
Mailing address:
  • Phone: 949-215-5055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA61958
License Number StateCA

VIII. Authorized Official

Name: TENEESE NGUYEN
Title or Position: OWNER
Credential: MD
Phone: 949-215-5055