Provider Demographics
NPI:1265463608
Name:ORANGE COUNTY HEART INSTITUTE AND RESEARCH CENTER A MEDICAL GROUP
Entity Type:Organization
Organization Name:ORANGE COUNTY HEART INSTITUTE AND RESEARCH CENTER A MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SANTORA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-564-3300
Mailing Address - Street 1:1140 W LA VETA AVE STE 640
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4228
Mailing Address - Country:US
Mailing Address - Phone:714-564-3300
Mailing Address - Fax:949-231-5108
Practice Address - Street 1:1140 W LA VETA AVE STE 640
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4228
Practice Address - Country:US
Practice Address - Phone:714-564-3300
Practice Address - Fax:949-231-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW13178207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0064090Medicaid
CA=========OtherTAX I.D.NUMBER