Provider Demographics
NPI:1457500217
Name:ORLAND CHILDREN'S CENTER, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ORLAND CHILDREN'S CENTER, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:ORLAND CHILDREN'S CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YUSUF
Authorized Official - Middle Name:
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-865-5400
Mailing Address - Street 1:116 E WALKER ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95963-1526
Mailing Address - Country:US
Mailing Address - Phone:530-865-5400
Mailing Address - Fax:530-865-5455
Practice Address - Street 1:116 E WALKER ST
Practice Address - Street 2:
Practice Address - City:ORLAND
Practice Address - State:CA
Practice Address - Zip Code:95963-1526
Practice Address - Country:US
Practice Address - Phone:530-865-5400
Practice Address - Fax:530-865-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36861261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A734650Medicaid
CA058936Medicare Oscar/Certification
CA00A734650Medicare PIN