MEDICARE: CHILDREN'S HOSPITAL OF ORANGE COUNTY

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center
2	282NC2000X	Children's Hospital

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3253	OTHER	CA	BLUE CROSS
3	0001	OTHER	CA	CHAMPUS
4	CHOC	OTHER	CA	UNIVERSAL CARE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	ZZZD3004Z	OTHER	CA	BLUE SHIELD

NPI Number	:	1811080526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S HOSPITAL OF ORANGE COUNTY

Provider Business Mailing Address
First Line	:	1201 W LA VETA AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4203
Country	:	US
Telephone Number	:	714-997-3000
Fax Number	:	714-532-8753

Provider Business Practice Location Address
First Line	:	1201 W LA VETA AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92868-4203
Country	:	US
Telephone Number	:	714-997-3000
Fax Number	:	714-532-8753

Authorized Official
Title or Position	:	SR. VICE PRESIDENT MEDICAL AFFAIRS
Name	:	DR. SANDIP GODAMBE
Credential	:	MD
Telephone Number	:	714-509-8413

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	10/24/2025

3 SAINT STEPHENS PL , SUITE 2
WARWICK, NY
10990-3208

Practice Phone: 845-987-9700
Practice Fax: