Healthcare Provider Details

I. General information

NPI: 1205228046
Provider Name (Legal Business Name): NORTH ORANGE COUNTY PEDIATRICS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 E YORBA LINDA BLVD STE 101
PLACENTIA CA
92870-7600
US

IV. Provider business mailing address

895 E YORBA LINDA BLVD STE 101
PLACENTIA CA
92870-7600
US

V. Phone/Fax

Practice location:
  • Phone: 714-988-2359
  • Fax: 714-582-0945
Mailing address:
  • Phone: 714-988-2359
  • Fax: 714-582-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG77828
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFRY GILL
Title or Position: PRESIDENT
Credential: M.D.,M.B.A.
Phone: 562-365-3540