Healthcare Provider Details

I. General information

NPI: 1225419302
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OF ORANGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA VETA AVE STE 470
ORANGE CA
92868-4233
US

IV. Provider business mailing address

1120 W LA VETA AVE STE 470
ORANGE CA
92868-4233
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-8481
  • Fax: 714-509-4374
Mailing address:
  • Phone: 714-509-8481
  • Fax: 714-509-4374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. MARIA MINON
Title or Position: CHIEF MEDICAL OFFICER AND VICE PRES
Credential: MD
Phone: 714-509-8413