Healthcare Provider Details

I. General information

NPI: 1912101668
Provider Name (Legal Business Name): JESSICA COLE MCMICHAEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR SUITE 508
ORANGE CA
92868-3854
US

IV. Provider business mailing address

1310 W STEWART DR SUITE 508
ORANGE CA
92868-3854
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-2111
  • Fax: 714-633-5615
Mailing address:
  • Phone: 714-633-2111
  • Fax: 714-633-5615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberA125386
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA125386
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: