Provider Demographics
NPI:1023110905
Name:ORANGE COUNTY NEUROLOGICAL MEDICAL GROUP INC
Entity type:Organization
Organization Name:ORANGE COUNTY NEUROLOGICAL MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-730-0311
Mailing Address - Street 1:PO BOX 17957
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-7957
Mailing Address - Country:US
Mailing Address - Phone:714-730-0311
Mailing Address - Fax:714-707-4762
Practice Address - Street 1:1211 W LA PALMA AVE STE 710
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2814
Practice Address - Country:US
Practice Address - Phone:714-730-0311
Practice Address - Fax:714-922-8093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-02
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW2346BMedicare PIN
CAW2346AMedicare PIN
CAW2346DMedicare PIN
CAHW2346FMedicare PIN
CAHW2346DMedicare PIN
CAHW2346JMedicare PIN
CAHW2346CMedicare PIN
CAW2346BMedicare PIN
CAW2346DMedicare PIN