Healthcare Provider Details

I. General information

NPI: 1417111873
Provider Name (Legal Business Name): OCCUPATIONAL HEALTH CENTERS OF CALIFORNIA, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 E COLORADO BLVD
PASADENA CA
91105-1936
US

IV. Provider business mailing address

5080 SPECTRUM DRIVE SUITE 1200 WEST TOWER
ADDISON TX
75001
US

V. Phone/Fax

Practice location:
  • Phone: 626-578-2600
  • Fax: 626-578-2610
Mailing address:
  • Phone: 626-578-2600
  • Fax: 626-578-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. TOM FOGARTY
Title or Position: EVP, CMO
Credential: MD
Phone: 800-232-3550