Provider Demographics
NPI:1902038169
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 1:875 N BREA BLVD
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2606
Mailing Address - Country:US
Mailing Address - Phone:714-529-6842
Mailing Address - Fax:714-256-1041
Practice Address - Street 1:875 N BREA BLVD
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821
Practice Address - Country:US
Practice Address - Phone:714-529-6842
Practice Address - Fax:714-256-1041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
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
CAHSP30711FMedicaid
052039Medicare Oscar/Certification