Healthcare Provider Details

I. General information

NPI: 1851059794
Provider Name (Legal Business Name): ORANGE COUNTY PEDIATRIC UROLOGY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

505 S MAIN ST STE 100
ORANGE CA
92868-4568
US

V. Phone/Fax

Practice location:
  • Phone: 714-503-8504
  • Fax:
Mailing address:
  • Phone: 714-509-3919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ELIAS WEHBI
Title or Position: MEMBER
Credential: MD
Phone: 714-456-7005