Basic Information
| Provider Information | |||||||||
| NPI: | 1710398193 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORANGE COAST HEAD AND NECK SURGERY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16100 SAND CANYON AVE | ||||||||
| Address2: | STE 310 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926183716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497150500 | ||||||||
| FaxNumber: | 9497150503 | ||||||||
| Practice Location | |||||||||
| Address1: | 16100 SAND CANYON AVE | ||||||||
| Address2: | STE 310 | ||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926183716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497150500 | ||||||||
| FaxNumber: | 9497150503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2014 | ||||||||
| LastUpdateDate: | 05/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | RENTERIA | ||||||||
| AuthorizedOfficialFirstName: | LAURA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9497150500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | W20172 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.