Healthcare Provider Details

I. General information

NPI: 1821204058
Provider Name (Legal Business Name): THC - ORANGE COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 W SLAUSON AVE
LOS ANGELES CA
90056
US

IV. Provider business mailing address

5525 W SLAUSON AVE
LOS ANGELES CA
90056-1047
US

V. Phone/Fax

Practice location:
  • Phone: 310-642-0325
  • Fax: 310-642-0338
Mailing address:
  • Phone: 310-642-0325
  • Fax: 310-642-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MOSTAFA ADAM DARVISH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 714-893-4541