Provider Demographics
NPI:1205935061
Name:SOUTH ORANGE COUNTY ENDOCRINOLOGY
Entity type:Organization
Organization Name:SOUTH ORANGE COUNTY ENDOCRINOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANNAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-770-9494
Mailing Address - Street 1:24012 CALLE DE LA PLATA
Mailing Address - Street 2:345
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3621
Mailing Address - Country:US
Mailing Address - Phone:949-770-9494
Mailing Address - Fax:949-770-9639
Practice Address - Street 1:24012 CALLE DE LA PLATA
Practice Address - Street 2:345
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3621
Practice Address - Country:US
Practice Address - Phone:949-770-9494
Practice Address - Fax:949-770-9639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW13374Medicare PIN