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General NPI Number Information
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NPI Number | 1821488438
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Entity Type | Organization
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Legal Business Name | OB/GYN UNIVERSITY ASSOCIATES- FOUNTAIN VALLEY
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Dates
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Enumeration Date | 02/03/2015
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Last Update Date | 02/03/2015
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Provider Practice Location Address
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Address Line | 11190 WARNER AVE SUITE 402
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-4019
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Country | US
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Telephone | 714-556-3902
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Fax | 714-432-1367
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Provider Business Mailing Address
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Address Line | PO BOX 513980
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City | LOS ANGELES
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State | CA
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Zip | 90051-3980
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Country | US
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Telephone | 714-456-6431
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Fax | 714-456-7754
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Authorized Official
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Title or Position | INTERIM PRESIDENT
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Name | ROGER L. CRUMLEY
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Credential | MD
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Telephone | 714-456-2986
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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