Healthcare Provider Details

I. General information

NPI: 1376249870
Provider Name (Legal Business Name): ORANGE COUNTY ORTHOPEDIC AND PAIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/08/2023
Certification Date: 02/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26921 CROWN VALLEY PKWY STE 120
MISSION VIEJO CA
92691-6501
US

IV. Provider business mailing address

26921 CROWN VALLEY PKWY STE 120
MISSION VIEJO CA
92691-6501
US

V. Phone/Fax

Practice location:
  • Phone: 949-333-2224
  • Fax:
Mailing address:
  • Phone: 949-333-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ALIREZA BOZORGI
Title or Position: CEO
Credential: MD
Phone: 949-333-2224