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General NPI Number Information
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NPI Number | 1619891553
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Entity Type | Organization
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Legal Business Name | ORANGE PREVENTION AND TREATMENT INTEGRATED MEDICAL ASSISTANCE
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Dates
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Enumeration Date | 08/05/2026
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Last Update Date | 08/05/2026
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Provider Practice Location Address
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Address Line | 7900 GARDEN GROVE BLVD
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City | GARDEN GROVE
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State | CA
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Zip | 92841-4208
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Country | US
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Telephone | 661-733-2858
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Fax |
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Provider Business Mailing Address
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Address Line | 505 CITY PKWY W
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City | ORANGE
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State | CA
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Zip | 92868-2924
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Country | US
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Telephone | 661-733-2858
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR, MEDI-CAL/CALAIM
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Name | KELLY ANN NELSON
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Credential | DSW
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Telephone | 661-733-2858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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