Provider Demographics
NPI:1790994259
Name:ST. JOSEPH HOSPITAL OF ORANGE
Entity Type:Organization
Organization Name:ST. JOSEPH HOSPITAL OF ORANGE
Other - Org Name:PUENTE A LA SALUD MOBILE CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-771-8000
Mailing Address - Street 1:363 S MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3833
Mailing Address - Country:US
Mailing Address - Phone:714-744-8801
Mailing Address - Fax:714-744-8629
Practice Address - Street 1:363 S MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3833
Practice Address - Country:US
Practice Address - Phone:714-744-8801
Practice Address - Fax:714-744-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QM1000X, 261QM1000X, 261QM1000X, 261QM1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG93665-02OtherDENTICAL
CACMM7079OFOtherMEDI-CAL
CAEAP70367FOther(EAPC)