Basic Information
| Provider Information | |||||||||
| NPI: | 1811080526 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S HOSPITAL OF ORANGE COUNTY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 W LA VETA AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92868 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149973000 | ||||||||
| FaxNumber: | 7145328753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 W LA VETA AVE | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928684203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149973000 | ||||||||
| FaxNumber: | 7145328753 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 10/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | GODAMBE | ||||||||
| AuthorizedOfficialFirstName: | SANDIP | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR. VICE PRESIDENT MEDICAL AFFAIRS | ||||||||
| AuthorizedOfficialTelephone: | 7145098413 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | Y | Hospitals | General Acute Care Hospital | Children |
ID Information
| ID | Type | State | Issuer | Description | CHOC | 01 | CA | UNIVERSAL CARE | OTHER | ZZZD3004Z | 01 | CA | BLUE SHIELD | OTHER | ZZT41404F | 05 | CA | MEDICAID | 3253 | 01 | CA | BLUE CROSS | OTHER | 0001 | 01 | CA | CHAMPUS | OTHER | HSC31404F | 05 | CA | MEDICAID |