Provider Demographics
NPI:1205228046
Name:NORTH ORANGE COUNTY PEDIATRICS MEDICAL GROUP INC
Entity type:Organization
Organization Name:NORTH ORANGE COUNTY PEDIATRICS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MBA
Authorized Official - Phone:562-365-3540
Mailing Address - Street 1:895 E YORBA LINDA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-7600
Mailing Address - Country:US
Mailing Address - Phone:714-988-2359
Mailing Address - Fax:714-582-0945
Practice Address - Street 1:895 E YORBA LINDA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-7600
Practice Address - Country:US
Practice Address - Phone:714-988-2359
Practice Address - Fax:714-582-0945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77828208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty