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General NPI Number Information
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NPI Number | 1679914808
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Entity Type | Organization
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Legal Business Name | ORANGE COUNTY MIGRAINE & HEADACHE CENTER
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 33 CREEK RD 340
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City | IRVINE
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State | CA
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Zip | 92604-4791
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Country | US
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Telephone | 949-861-8717
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Fax | 949-861-8719
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Provider Business Mailing Address
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Address Line | PO BOX 54726
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City | IRVINE
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State | CA
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Zip | 92619-4726
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Country | US
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Telephone | 949-861-8717
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Fax | 949-861-8719
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Authorized Official
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Title or Position | PRESIDENT
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Name | SUSAN L HUTCHINSON
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Credential | M.D.
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Telephone | 949-861-8717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G48346
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License Number State | CA
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