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General NPI Number Information
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NPI Number | 1073927877
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Entity Type | Organization
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Legal Business Name | SOUTH ORANGE COUNTY COMMUNITY COLLEGE DISTRICT
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Dates
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Enumeration Date | 06/19/2014
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 5500 IRVINE CENTER DR
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City | IRVINE
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State | CA
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Zip | 92618-0301
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Country | US
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Telephone | 949-451-5221
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Fax | 949-451-5393
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Provider Business Mailing Address
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Address Line | 5500 IRVINE CENTER DR STUDENT HEATLH, WELLNESS & VETERANS CENTER - SSC 150
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City | IRVINE
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State | CA
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Zip | 92618-0301
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Country | US
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Telephone | 949-451-5221
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Fax | 949-451-5393
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Authorized Official
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Title or Position | DIRECTOR HEALTH,WELLNESS,VET CENTER
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Name | NANCY MONTGOMERY
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Credential |
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Telephone | 949-451-5273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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