Basic Information
| Provider Information | |||||||||
| NPI: | 1558431940 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORANGE COUNTY HEALTH CARE AGENCY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12 BLOOMFIELD LN | ||||||||
| Address2: | |||||||||
| City: | RANCHO SANTA MARGARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926888715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498888430 | ||||||||
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| Practice Location | |||||||||
| Address1: | 405 W 5TH ST | ||||||||
| Address2: | SUITE 590 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927014519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148345015 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KOPIEC | ||||||||
| AuthorizedOfficialFirstName: | TAMRA | ||||||||
| AuthorizedOfficialMiddleName: | LYN | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL SOCIAL WORKER | ||||||||
| AuthorizedOfficialTelephone: | 9497072110 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | LCS23063 | CA | Y | Agencies | Public Health or Welfare |
No ID Information.