Provider Demographics
NPI:1952864431
Name:OC GERIATRIC
Entity Type:Organization
Organization Name:OC GERIATRIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:REZA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALEBI DOLOUEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-962-8631
Mailing Address - Street 1:1735 W ROMNEYA DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1804
Mailing Address - Country:US
Mailing Address - Phone:714-776-5920
Mailing Address - Fax:
Practice Address - Street 1:1735 W ROMNEYA DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-776-5920
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-10
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center