Provider Demographics
NPI:1689067985
Name:OC RHEUMATOLOGY
Entity Type:Organization
Organization Name:OC RHEUMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GAYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOKOOTSEDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-335-7993
Mailing Address - Street 1:25401 CABOT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-5513
Mailing Address - Country:US
Mailing Address - Phone:949-335-7993
Mailing Address - Fax:
Practice Address - Street 1:25401 CABOT RD STE 101
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-5513
Practice Address - Country:US
Practice Address - Phone:949-335-7993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62644207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty