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General NPI Number Information
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NPI Number | 1205924511
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Entity Type | Organization
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Legal Business Name | ORANGE COUNTY EAR, NOSE & THROAT
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 09/22/2022
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Provider Practice Location Address
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Address Line | 22 ODYSSEY STE 100
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City | IRVINE
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State | CA
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Zip | 92618-3186
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Country | US
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Telephone | 949-679-9000
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Fax | 949-679-9001
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Provider Business Mailing Address
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Address Line | 24411 HEALTH CENTER DRIVE SUITE 600
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City | LAGUNA HILLS
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State | CA
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Zip | 92653
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Country | US
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Telephone | 949-305-8000
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Fax | 949-305-8001
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. MICHELLE CRYSTAL DENA
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Credential |
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Telephone | 949-305-8252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | CA
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