Basic Information
| Provider Information | |||||||||
| NPI: | 1275757510 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OC GYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 AVOCADO AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926607725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497193600 | ||||||||
| FaxNumber: | 9496447344 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 AVOCADO AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926607725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497193600 | ||||||||
| FaxNumber: | 9496447344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MCCLELLAN | ||||||||
| AuthorizedOfficialFirstName: | STEPHANIE | ||||||||
| AuthorizedOfficialMiddleName: | N. | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 9497193600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.