Provider Demographics
NPI:1851790331
Name:HOAG OUTPATIENT THERAPIES LLC
Entity Type:Organization
Organization Name:HOAG OUTPATIENT THERAPIES LLC
Other - Org Name:WOMANOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:GUARNI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-764-4624
Mailing Address - Street 1:500 SUPERIOR AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3657
Mailing Address - Country:US
Mailing Address - Phone:949-764-4624
Mailing Address - Fax:949-764-5820
Practice Address - Street 1:18271 MCDURMOTT W STE J
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-6754
Practice Address - Country:US
Practice Address - Phone:949-752-2227
Practice Address - Fax:949-752-2231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-20
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy