Healthcare Provider Details

I. General information

NPI: 1508902289
Provider Name (Legal Business Name): ORANGE COUNTY PEDIATRIC CARDIOLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 06/11/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR SUITE 407
ORANGE CA
92868-3854
US

IV. Provider business mailing address

1310 W STEWART DR SUITE 407
ORANGE CA
92868-3854
US

V. Phone/Fax

Practice location:
  • Phone: 714-538-8887
  • Fax:
Mailing address:
  • Phone: 714-538-8887
  • Fax:

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: DANA SIMS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 714-538-5558