Provider Demographics
NPI:1083240204
Name:CHOC PHYSICIANS NETWORK, INC
Entity Type:Organization
Organization Name:CHOC PHYSICIANS NETWORK, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLSZTEJN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-754-1548
Mailing Address - Street 1:1120 W. LA VETA AVENUE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-565-5100
Mailing Address - Fax:714-509-7016
Practice Address - Street 1:1120 W. LA VETA AVENUE
Practice Address - Street 2:SUITE 450
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-565-5100
Practice Address - Fax:714-509-7016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization