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General NPI Number Information
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NPI Number | 1518882539
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Entity Type | Organization
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Legal Business Name | ORDER OF MALTA CLINIC OF ORANGE INC.
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Dates
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Enumeration Date | 08/10/2026
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Last Update Date | 08/10/2026
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Provider Practice Location Address
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Address Line | 2424 N GRAND AVE STE C
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City | SANTA ANA
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State | CA
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Zip | 92705-8758
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Country | US
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Telephone | 714-831-1541
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Fax | 714-592-0736
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Provider Business Mailing Address
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Address Line | 21271 CALLE HORIZONTE
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City | LAKE FOREST
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State | CA
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Zip | 92630-2145
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Country | US
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Telephone | 949-309-8434
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | RICHARD KOZAK
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Credential | MD
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Telephone | 949-309-8434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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