Basic Information
| Provider Information | |||||||||
| NPI: | 1326331315 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | UNITED CEREBRAL PALSY OF ORANGE COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 980 ROOSEVELT | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926203672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493336413 | ||||||||
| FaxNumber: | 9493336441 | ||||||||
| Practice Location | |||||||||
| Address1: | 980 ROOSEVELT | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926203672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493336413 | ||||||||
| FaxNumber: | 9493336441 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2011 | ||||||||
| LastUpdateDate: | 06/09/2011 | ||||||||
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| AuthorizedOfficialLastName: | MCCONNELL | ||||||||
| AuthorizedOfficialFirstName: | CHRISTINE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SLP | ||||||||
| AuthorizedOfficialTelephone: | 9493336437 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | UNITED CEREBRAL PALSY OF ORANGE COUNTY | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | SP17144 | CA | Y | Agencies | Early Intervention Provider Agency |
No ID Information.