Provider Demographics
NPI:1548576846
Name:ORANGE COAST COLLEGE STUDENT HEALTH CENTER
Entity Type:Organization
Organization Name:ORANGE COAST COLLEGE STUDENT HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE DEAN OF STUDENT HEALTH
Authorized Official - Prefix:MS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:WORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:714-432-5026
Mailing Address - Street 1:2701 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-5563
Mailing Address - Country:US
Mailing Address - Phone:714-432-5808
Mailing Address - Fax:714-432-5097
Practice Address - Street 1:2701 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5563
Practice Address - Country:US
Practice Address - Phone:714-432-5808
Practice Address - Fax:714-432-5097
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORANGE COAST COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health