Healthcare Provider Details

I. General information

NPI: 1992206940
Provider Name (Legal Business Name): OC HEALTHY HEART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2018
Last Update Date: 09/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 E KATELLA AVE SUITE B
ORANGE CA
92867
US

IV. Provider business mailing address

438 E KATELLA AVE SUITE B
ORANGE CA
92867
US

V. Phone/Fax

Practice location:
  • Phone: 951-312-5922
  • Fax:
Mailing address:
  • Phone: 714-744-5000
  • Fax: 714-744-5985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number134183
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number134183
License Number StateCA

VIII. Authorized Official

Name: DR. JACQUELINE EUBANY
Title or Position: BOARD MEMBER
Credential: MD
Phone: 951-312-5922