Provider Demographics
NPI:1437269354
Name:THE BREAST CARE CENTER OF ORANGE COUNTY, INC.
Entity Type:Organization
Organization Name:THE BREAST CARE CENTER OF ORANGE COUNTY, INC.
Other - Org Name:THE BREAST CARE CENTER/THE ONCOLOGY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:COLUZZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-541-0101
Mailing Address - Street 1:230 S MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3851
Mailing Address - Country:US
Mailing Address - Phone:714-541-0101
Mailing Address - Fax:714-619-3322
Practice Address - Street 1:230 S MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3851
Practice Address - Country:US
Practice Address - Phone:714-541-0101
Practice Address - Fax:714-619-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58036174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW10689Medicare ID - Type Unspecified