Provider Demographics
NPI:1811564479
Name:ASCADA HEALTH PC
Entity Type:Organization
Organization Name:ASCADA HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:OEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:657-295-1333
Mailing Address - Street 1:301 W BASTANCHURY RD STE 220
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3424
Mailing Address - Country:US
Mailing Address - Phone:657-230-7337
Mailing Address - Fax:657-272-7720
Practice Address - Street 1:301 W BASTANCHURY RD STE 220
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3424
Practice Address - Country:US
Practice Address - Phone:657-230-7337
Practice Address - Fax:657-272-7720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-10
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty