Provider Demographics
NPI:1073373726
Name:CHAMPION HEALTH PLAN OF CALIFORNIA
Entity Type:Organization
Organization Name:CHAMPION HEALTH PLAN OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-682-9395
Mailing Address - Street 1:19700 FAIRCHILD STE 230
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2514
Mailing Address - Country:US
Mailing Address - Phone:800-511-4450
Mailing Address - Fax:
Practice Address - Street 1:19700 FAIRCHILD STE 230
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2514
Practice Address - Country:US
Practice Address - Phone:800-511-4450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization