Healthcare Provider Details

I. General information

NPI: 1770763633
Provider Name (Legal Business Name): NORTH ORANG COUNTY PEDIATRICS CHILES DAN W ET AL GEN PTRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 E YORBA LINDA BLVD SUITE 101
PLACENTIA CA
92870-3695
US

IV. Provider business mailing address

895 E YORBA LINDA BLVD SUITE 101
PLACENTIA CA
92870-3695
US

V. Phone/Fax

Practice location:
  • Phone: 714-528-5112
  • Fax: 714-996-9355
Mailing address:
  • Phone: 714-528-5112
  • Fax: 714-996-9355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA23480
License Number StateCA

VIII. Authorized Official

Name: CHARLES J BACHA
Title or Position: PHYSICIAN
Credential: MD
Phone: 714-528-5112