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General NPI Number Information
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NPI Number | 1982871729
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Entity Type | Organization
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Legal Business Name | PEDIATRICS & NEONATOLOGY MEDICAL GROUP OF ORANGE COUNTY INC
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 12665 GARDEN GROVE BLVD SUITE 713
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City | GARDEN GROVE
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State | CA
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Zip | 92843-1921
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Country | US
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Telephone | 714-537-6595
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Fax | 714-537-2176
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Provider Business Mailing Address
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Address Line | P.O. BOX 8500
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City | NEWPORT BEACH
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State | CA
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Zip | 92658-8500
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Country | US
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Telephone | 714-537-6595
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Fax | 714-537-2176
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Authorized Official
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Title or Position | PRESIDENT/CEO/OWNER
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Name | JACOB SWEIDAN
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Credential | M.D.
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Telephone | 714-915-4656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 180024
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License Number State | CA
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