=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871910315
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH CARE AGENCY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2014
-----------------------------------------------------
Last Update Date | 03/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 734 ESTANCIA
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92602-1116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-389-0105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 734 ESTANCIA
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92602-1116
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-389-0105
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CCRN II
-----------------------------------------------------
Name | MARY NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-389-0105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | RN742737
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------