Provider Demographics
NPI:1457886236
Name:ORANGE COUNTY PROFESSIONAL MEDICAL GROUP
Entity Type:Organization
Organization Name:ORANGE COUNTY PROFESSIONAL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-600-6760
Mailing Address - Street 1:4103 N VIKING WAY
Mailing Address - Street 2:SUITE D
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1490
Mailing Address - Country:US
Mailing Address - Phone:714-600-6760
Mailing Address - Fax:714-935-9559
Practice Address - Street 1:4103 N VIKING WAY
Practice Address - Street 2:SUITE D
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-1490
Practice Address - Country:US
Practice Address - Phone:714-600-6760
Practice Address - Fax:714-935-9559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71823261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty