Healthcare Provider Details

I. General information

NPI: 1538449616
Provider Name (Legal Business Name): PSF CARDIOLOGY COMMERCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 08/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MAIN ST STE 200
ORANGE CA
92868-4509
US

IV. Provider business mailing address

455 S MAIN ST
ORANGE CA
92868-3835
US

V. Phone/Fax

Practice location:
  • Phone: 714-516-4295
  • Fax:
Mailing address:
  • Phone: 714-516-4295
  • 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: ELIZABETH FARACE
Title or Position: MANAGER
Credential:
Phone: 714-516-4295