MEDICARE: COUNTY OF ORANGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346387743
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNTY OF ORANGE

Provider Business Mailing Address
First Line	:	405 W 5TH ST STE 212
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-4522
Country	:	US
Telephone Number	:	714-568-5614
Fax Number	:	714-834-6595

Provider Business Practice Location Address
First Line	:	2801 BRISTOL ST
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-5996
Country	:	US
Telephone Number	:	714-850-8408
Fax Number	:

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	DR. CHI Y RAJALINGAM
Credential	:	PH.D., CHC
Telephone Number	:	714-834-3154

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/14/2020

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Directions to “COUNTY OF ORANGE ” Practice Location

Language	Start Address	Practice Location

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