Provider Demographics
NPI:1356525182
Name:NORTH ORANGE COUNTY PEDIATRICS CHILES DAN W ET AL GEN PTRS
Entity type:Organization
Organization Name:NORTH ORANGE COUNTY PEDIATRICS CHILES DAN W ET AL GEN PTRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BACHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-879-2980
Mailing Address - Street 1:220 LAGUNA RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2523
Mailing Address - Country:US
Mailing Address - Phone:714-879-2980
Mailing Address - Fax:714-879-5134
Practice Address - Street 1:220 LAGUNA RD
Practice Address - Street 2:SUITE 5
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2523
Practice Address - Country:US
Practice Address - Phone:714-879-2980
Practice Address - Fax:714-879-5134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-28
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA234802080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0024380Medicaid
CAA26098OtherMEDICAL LIC NUMBER
CAGR0024380Medicaid