Healthcare Provider Details

I. General information

NPI: 1245505866
Provider Name (Legal Business Name): PEDIATRIX CARDIOLOGY OF ORANGE COUNTY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 07/09/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W. LA VETA AVE SUITE 575
ORANGE CA
92868-4305
US

IV. Provider business mailing address

1301 CONCORD TER
SUNRISE FL
33323-2843
US

V. Phone/Fax

Practice location:
  • Phone: 714-547-0900
  • Fax: 714-547-2080
Mailing address:
  • Phone: 800-243-3839
  • Fax: 714-740-0326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: NANETTE SANDERS
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 800-243-3839