Provider Demographics
NPI:1811025778
Name:ORANGE INFERTILITY OBSTETRICAL AND GYNECOLOGICAL MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:ORANGE INFERTILITY OBSTETRICAL AND GYNECOLOGICAL MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:LUJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-633-0886
Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:311
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-633-0886
Mailing Address - Fax:714-633-8804
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:311
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-633-0886
Practice Address - Fax:714-633-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG425530207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW12061Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER