Healthcare Provider Details

I. General information

NPI: 1427093046
Provider Name (Legal Business Name): HEAD AND NECK ASSOCIATES OF ORANGE COUNTY AN INCORPRATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date: 09/25/2007
Reactivation Date: 02/27/2008

III. Provider practice location address

26726 CROWN VALLEY PKWY #200
MISSION VIEJO CA
92691-8003
US

IV. Provider business mailing address

26726 CROWN VALLEY KWY #200
MISSION VIEJO CA
92691-8003
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-4361
  • Fax: 949-364-4495
Mailing address:
  • Phone: 949-364-4361
  • Fax: 949-364-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JOHN S SUPANCE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 949-364-4361