Healthcare Provider Details

I. General information

NPI: 1861516809
Provider Name (Legal Business Name): OBRIA MEDICAL CLINICS OF SOUTHERN CALIFORNIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E. 1ST STREET SUITE 209
SANTA ANA CA
92705-4048
US

IV. Provider business mailing address

2001 E. 1ST STREET SUITE 209
SANTA ANA CA
92705-4048
US

V. Phone/Fax

Practice location:
  • Phone: 714-516-9045
  • Fax: 714-516-9080
Mailing address:
  • Phone: 714-516-9045
  • Fax: 714-516-9080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HENRY W TAYLOR
Title or Position: CEO
Credential:
Phone: 800-771-5089