Basic Information
| Provider Information | |||||||||
| NPI: | 1578607495 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCCUPATIONAL HEALTH CENTERS OF CALIFORNIA, A MEDICAL CORPORATION | ||||||||
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| OtherOrganizationName: | CONCENTRA MEDICAL CENTER, A MEDICAL CORPORATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5080 SPECTRUM DRIVE | ||||||||
| Address2: | SUITE 1200 WEST TOWER | ||||||||
| City: | ADDISON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723648000 | ||||||||
| FaxNumber: | 2147754502 | ||||||||
| Practice Location | |||||||||
| Address1: | 2121 TOWNE CENTRE PLACE | ||||||||
| Address2: | STE 100 | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149371919 | ||||||||
| FaxNumber: | 7149371966 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/16/2007 | ||||||||
| LastUpdateDate: | 02/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | WAINSTEIN | ||||||||
| AuthorizedOfficialFirstName: | JEFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VP / CHIEF MEDICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9723648000 | ||||||||
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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 | 261QP2000X | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 261QX0100X | N | Ambulatory Health Care Facilities | Clinic/Center | Occupational Medicine | 261QH0100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Health Service |
No ID Information.