Healthcare Provider Details

I. General information

NPI: 1699889923
Provider Name (Legal Business Name): WEST COAST PEDIATRIC NEUROSURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 03/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 WEST LA VETA AVE SUITE 710
ORANGE CA
92868
US

IV. Provider business mailing address

1010 WEST LA VETA AVE SUITE 710
ORANGE CA
92868
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-2724
  • Fax: 714-835-2751
Mailing address:
  • Phone: 714-835-2724
  • Fax: 714-835-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL G MUHONEN
Title or Position: PRESIDENT
Credential: MD
Phone: 714-835-2741