Healthcare Provider Details

I. General information

NPI: 1578795738
Provider Name (Legal Business Name): THC - ORANGE COUNTY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 07/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 N MONTEREY AVE
ONTARIO CA
91764
US

IV. Provider business mailing address

550 N MONTEREY AVE
ONTARIO CA
91764-3318
US

V. Phone/Fax

Practice location:
  • Phone: 909-391-0333
  • Fax: 909-391-2892
Mailing address:
  • Phone: 909-391-0333
  • Fax: 909-391-2892

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