Provider Demographics
NPI:1619939691
Name:IRENE PE, MD PC
Entity Type:Organization
Organization Name:IRENE PE, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-530-5100
Mailing Address - Street 1:12665 GARDEN GROVE BLVD
Mailing Address - Street 2:STE. 606
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1901
Mailing Address - Country:US
Mailing Address - Phone:714-530-5100
Mailing Address - Fax:
Practice Address - Street 1:12665 GARDEN GROVE BLVD
Practice Address - Street 2:STE. 606
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1901
Practice Address - Country:US
Practice Address - Phone:714-530-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49301261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center