Provider Demographics
NPI:1114483492
Name:ORANGE COUNTY DIGESTIVE CENTER, INC
Entity Type:Organization
Organization Name:ORANGE COUNTY DIGESTIVE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ESSAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:QURAISHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-771-9910
Mailing Address - Street 1:1400 REYNOLDS AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5563
Mailing Address - Country:US
Mailing Address - Phone:657-900-4536
Mailing Address - Fax:657-208-9732
Practice Address - Street 1:1400 REYNOLDS AVE STE 125
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5563
Practice Address - Country:US
Practice Address - Phone:657-900-4536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical