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General NPI Number Information
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NPI Number | 1457687238
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Entity Type | Organization
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Legal Business Name | PEDITRIC SUBSPECIALY FACULTY
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Dates
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Enumeration Date | 10/28/2009
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Last Update Date | 10/28/2009
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Provider Practice Location Address
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Address Line | 500 SUPERIOR AVE
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-3657
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Country | US
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Telephone | 714-516-4295
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Fax |
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Provider Business Mailing Address
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Address Line | 455 S MAIN ST
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City | ORANGE
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State | CA
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Zip | 92868-3835
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Country | US
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Telephone | 714-516-4295
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Fax |
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Authorized Official
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Title or Position | REVENUE CYCLE MANAGER
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Name | MRS. ELIZABETH FARACE FARACE
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Credential |
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Telephone | 714-516-4295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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