Healthcare Provider Details

I. General information

NPI: 1790994259
Provider Name (Legal Business Name): ST. JOSEPH HOSPITAL OF ORANGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 S MAIN ST SUITE 204
ORANGE CA
92868-3833
US

IV. Provider business mailing address

363 S MAIN ST SUITE 204
ORANGE CA
92868-3833
US

V. Phone/Fax

Practice location:
  • Phone: 714-744-8801
  • Fax: 714-744-8629
Mailing address:
  • Phone: 714-744-8801
  • Fax: 714-744-8629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1000X
TaxonomyMigrant Health Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM1000X
TaxonomyMigrant Health Clinic/Center
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QM1000X
TaxonomyMigrant Health Clinic/Center
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code261QM1000X
TaxonomyMigrant Health Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ALAN H GARRETT
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 714-771-8000