Healthcare Provider Details

I. General information

NPI: 1497887384
Provider Name (Legal Business Name): COUNTY OF ORANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 12/20/2019
Certification Date: 12/20/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 THE CITY DR S 2ND FLOOR
ORANGE CA
92868-3205
US

IV. Provider business mailing address

405 W 5TH ST STE 212
SANTA ANA CA
92701-4522
US

V. Phone/Fax

Practice location:
  • Phone: 714-935-6363
  • Fax:
Mailing address:
  • Phone: 714-568-5614
  • Fax: 714-834-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHI Y RAJALINGAM
Title or Position: CHIEF COMPLIANCE OFFICER
Credential: PH.D., CHC
Phone: 714-834-3154