Provider Demographics
NPI:1699199596
Name:ORANGE PREVENTION AND TREATMENT INTEGRATED MEDICAL ASSISTANCE
Entity Type:Organization
Organization Name:ORANGE PREVENTION AND TREATMENT INTEGRATED MEDICAL ASSISTANCE
Other - Org Name:CALOPTIMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MSSP SITE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PIJLOO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:714-246-8500
Mailing Address - Street 1:505 CITY PKWY W
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2924
Mailing Address - Country:US
Mailing Address - Phone:714-246-8500
Mailing Address - Fax:
Practice Address - Street 1:505 CITY PKWY W
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2924
Practice Address - Country:US
Practice Address - Phone:714-246-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management