Provider Demographics
NPI:1376886424
Name:CHILDREN'S HOSPITAL OF ORANGE COUNTY
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF ORANGE COUNTY
Other - Org Name:CS ALLERGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CS BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-509-7861
Mailing Address - Street 1:1201 W LA VETA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4203
Mailing Address - Country:US
Mailing Address - Phone:714-633-6363
Mailing Address - Fax:714-633-0178
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4203
Practice Address - Country:US
Practice Address - Phone:714-633-6363
Practice Address - Fax:714-633-0178
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL OF ORANGE COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-27
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty