Basic Information
| Provider Information | |||||||||
| NPI: | 1326223298 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORANGEWOOD SURGICAL CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2143 ORANGEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90051 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142214236 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2143 W ORANGEWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928681941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142214236 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2008 | ||||||||
| LastUpdateDate: | 01/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | LICEAGA | ||||||||
| AuthorizedOfficialFirstName: | ALVARO | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7142214236 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.