Provider Demographics
NPI:1821488438
Name:OB/GYN UNIVERSITY ASSOCIATES- FOUNTAIN VALLEY
Entity Type:Organization
Organization Name:OB/GYN UNIVERSITY ASSOCIATES- FOUNTAIN VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRUMLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-456-2986
Mailing Address - Street 1:PO BOX 513980
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-3980
Mailing Address - Country:US
Mailing Address - Phone:714-456-6431
Mailing Address - Fax:714-456-7754
Practice Address - Street 1:11190 WARNER AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4019
Practice Address - Country:US
Practice Address - Phone:714-556-3902
Practice Address - Fax:714-432-1367
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REGENTS OF THE UNIVERSITY OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service