Provider Demographics
NPI:1508902289
Name:ORANGE COUNTY PEDIATRIC CARDIOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:ORANGE COUNTY PEDIATRIC CARDIOLOGY MEDICAL GROUP
Other - Org Name:CHILDREN'S CARDIOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-538-5558
Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 407
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-538-8887
Mailing Address - Fax:
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:SUITE 407
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-538-8887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty