Provider Demographics
NPI:1003035882
Name:PERINATAL DX MEDICAL GRP OR ORANGE COUNTY
Entity Type:Organization
Organization Name:PERINATAL DX MEDICAL GRP OR ORANGE COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SONOGRAPHER
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:714-241-9742
Mailing Address - Street 1:11180 WARNER AVE
Mailing Address - Street 2:#263
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-7501
Mailing Address - Country:US
Mailing Address - Phone:714-241-9742
Mailing Address - Fax:714-241-0136
Practice Address - Street 1:11180 WARNER AVE
Practice Address - Street 2:#263
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7501
Practice Address - Country:US
Practice Address - Phone:714-241-9742
Practice Address - Fax:714-241-0136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ95475ZOtherBLUE SHIELD OF CA
CAGR0018070Medicaid
W8991Medicare ID - Type Unspecified