Provider Demographics
NPI:1821204058
Name:THC - ORANGE COUNTY, LLC
Entity Type:Organization
Organization Name:THC - ORANGE COUNTY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSTAFA
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:DARVISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-893-4541
Mailing Address - Street 1:5525 W SLAUSON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1047
Mailing Address - Country:US
Mailing Address - Phone:310-642-0325
Mailing Address - Fax:310-642-0338
Practice Address - Street 1:5525 W SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056
Practice Address - Country:US
Practice Address - Phone:310-642-0325
Practice Address - Fax:310-642-0338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC32032GMedicaid
CA=========OtherUNITED HEALTHCARE
CA=========OtherCIGNA
CA=========OtherBLUE CROSS
CA=========OtherAETNA
CA=========OtherHUMANA
CAHSC32032GMedicaid
CA=========OtherAETNA
W18024Medicare ID - Type UnspecifiedMEDICARE PART B NUMBER