Healthcare Provider Details

I. General information

NPI: 1659482859
Provider Name (Legal Business Name): ORANGE COUNTY HEALTH CARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST STE. 212
SANTA ANA CA
92701-4519
US

IV. Provider business mailing address

405 W 5TH ST STE. 212
SANTA ANA CA
92701-4519
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-6660
  • Fax:
Mailing address:
  • Phone: 714-480-6660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number21177
License Number StateCA

VIII. Authorized Official

Name: MS. ROBIN RAE FONTAINE
Title or Position: LICENCED CLINICAL SOCIAL WORKER II
Credential: LCSW
Phone: 714-480-6660