Basic Information
| Provider Information | |||||||||
| NPI: | 1518995505 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOUNTAIN VALLEY REGIONAL HOSPITAL & MEDICAL CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FOUNTAIN VALLEY REGIONAL HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | FILE 57545 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900740001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263004122 | ||||||||
| FaxNumber: | 7149668039 | ||||||||
| Practice Location | |||||||||
| Address1: | 17100 EUCLID ST | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927084004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149667200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HANLY | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7149668089 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FOUNTAIN VALLEY REGIONAL HOSPITAL & MEDICAL CENTER | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 06000109 | CA | Y | Hospital Units | Psychiatric Unit |
No ID Information.