=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003035882
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERINATAL DX MEDICAL GRP OR ORANGE COUNTY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11180 WARNER AVE #263
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-7501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-241-9742
-----------------------------------------------------
Fax | 714-241-0136
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11180 WARNER AVE #263
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-7501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-241-9742
-----------------------------------------------------
Fax | 714-241-0136
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SONOGRAPHER
-----------------------------------------------------
Name | PAM R REED
-----------------------------------------------------
Credential | RDMS
-----------------------------------------------------
Telephone | 714-241-9742
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------