Healthcare Provider Details

I. General information

NPI: 1194871137
Provider Name (Legal Business Name): COMMUNITY CARE HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 W 17TH ST SUITE 1
SANTA ANA CA
92706-3459
US

IV. Provider business mailing address

8041 NEWMAN AVE
HUNTINGTON BEACH CA
92647-7034
US

V. Phone/Fax

Practice location:
  • Phone: 714-285-9811
  • Fax: 714-285-9822
Mailing address:
  • Phone: 714-500-0200
  • Fax: 714-842-0716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number550000166
License Number StateCA

VIII. Authorized Official

Name: TRACEY K GOULD
Title or Position: CFO
Credential:
Phone: 714-500-0200