Provider Demographics
NPI:1790806321
Name:OBRIA MEDICAL CLINICS OF SOUTHERN CALIFORNIA, INC.
Entity Type:Organization
Organization Name:OBRIA MEDICAL CLINICS OF SOUTHERN CALIFORNIA, INC.
Other - Org Name:BIRTH CHOICE PREGNANCY CENTERS, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-273-6217
Mailing Address - Street 1:1200 MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-6749
Mailing Address - Country:US
Mailing Address - Phone:949-916-8868
Mailing Address - Fax:949-273-5041
Practice Address - Street 1:28201 MARGUERITE PKWY
Practice Address - Street 2:SUITE 13
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3719
Practice Address - Country:US
Practice Address - Phone:949-238-1122
Practice Address - Fax:949-481-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000150261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health